The Impact of Hearing Loss Treatment Scale-Up in Persons Aging with HIV on Dementia Risk, Quality of Life, and Healthcare Costs

项目摘要 当接受抗逆转录病毒疗法（ART）治疗时，艾滋病毒感染者（PWH）的预期寿命与 没有艾滋病毒的人，但由于慢性炎症等原因， 可使.与没有感染艾滋病毒的人相比，威尔斯亲王医院的痴呆症发病率增加了两倍。给定 由于缺乏治疗方法来显著改变痴呆症的病程，因此痴呆症的预防至关重要。 重要性 最近的证据表明，听力损失是痴呆症的主要可预防原因， 全世界所有的痴呆症都可能是由于听力损失。听力损失是常见的PWH和发生多达五个 比没有感染艾滋病毒的人早10年。此外，新的数据表明，助听器可以 大大降低了因听力损失而增加的痴呆症风险。尽管有可能 虽然威尔斯亲王医院的生活质素和痴呆症风险有所改善，但接受听力损失治疗的人数仍然偏低。 只有20%的听力损失患者使用助听器，威尔斯亲王医院可能面临更大的困难 助听器技术考虑到健康、保险不足等不利的社会决定因素， 护理的结构性障碍。鉴于艾滋病毒感染者中听力损失和痴呆症的高负担， 听力损失筛查和治疗在这一人群中可能特别重要。 在母体R01（R01AG069575）中，艾米丽·海尔博士和她的研究小组详细介绍了开发和 为老龄化的艾滋病毒感染者建立痴呆和多发病的模拟模型， （认知障碍、HIV、衰老、健康、精神健康和痴呆）模型。本行政 作为补充，研究小组将整合现有的，经过验证的听力损失自然史模型， 听力损失终身负担决策模型（DeciBHAL）， CHARMED扩展了多形态建模的能力。然后，团队将使用更新的CHARMED 预测听力损失筛查和扩大治疗规模的有效性和成本效益的模型 在老年威尔斯亲王医院该模型将预测老年PWH中痴呆风险的潜在降低， 听力损失筛查和治疗。该项目的结果将为未来的临床试验，临床实践， 以及照顾艾滋病毒感染者的卫生政策指导方针。

PROJECT SUMMARY When treated with antiretroviral therapy (ART), persons with HIV (PWH) are living life expectancies similar to persons without HIV but remain at increased risk for multimorbidity due to chronic inflammation among other causes. PWH experience a two-fold increase in dementia incidence compared with persons without HIV. Given the absence of treatments to substantially alter the course of dementia, dementia prevention is of critical importance. Recent evidence suggests that hearing loss is a leading preventable cause of dementia and that up to 8% of all dementia worldwide may be due to hearing loss. Hearing loss is common among PWH and occurs up to five years earlier than among persons without HIV. Further, emerging data have shown that hearing aids could substantially mitigate the increased risk of dementia due to hearing loss. Despite the potential for improvements in quality of life and dementia risk, hearing loss treatment uptake among PWH remains low. Only 20% of persons with hearing loss use hearing aids, and PWH may face increased difficulties accessing hearing aid technology given disadvantageous social determinants of health, underinsurance, and other structural barriers to care. Given the high burden of hearing loss and dementia among people aging with HIV, hearing loss screening and treatment may be especially important in this population. In the parent R01 (R01AG069575), Dr. Emily Hyle and her research team detailed methods for developing and populating a simulation model of dementia and multimorbidity for the aging HIV population, the CHARMED (Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia) model. In this administrative supplement, the research team will integrate an existing, validated model of hearing loss natural history and treatment, the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL), with the CHARMED to expand the capacity for multimorbidity modeling. The team will then use the updated CHARMED model to project the effectiveness and cost-effectiveness of hearing loss screening and treatment scale-up among aging PWH. The model will project the potential reduction in dementia risk among aging PWH due to hearing loss screening and treatment. The results of this project will inform future clinical trials, clinical practice, and health policy guidelines for the care of persons aging with HIV.