Supplement: Implementation Research Strategies for Heart, Lung, and Blood Co-morbidities in People Living with HIV - Research Coordinating Center

项目摘要 低收入和中等收入国家(LMIC)正面临着日益沉重的心肺、血液和睡眠负担 艾滋病毒携带者(PWH)的(HLBS)障碍。在实施干预措施以减轻这一负担时， 对成本、成本效益和预算影响的评估越来越重要。此外， 在低收入国家实施综合护理涉及到独特的经济考虑。例如，推出这样的 干预措施往往涉及重大的前期成本(例如，重组保健系统、投资于技术 或其他基础设施)，而健康效益更不确定，只会随着时间的推移而增加。同样，它也是 很难将综合护理的成本与非综合护理标准进行比较，在这种标准中， 高血压等传染性疾病(NCDs)往往根本不被诊断或治疗。卫生与公众服务部- Simple Alliance是一个高度协作的联盟，正在评估多样化和 在六个撒哈拉以南非洲国家开展与文化相关的高血压控制干预措施 (南非、博茨瓦纳、赞比亚、莫桑比克、乌干达和尼日利亚)。以指定的成本为首- 效率小组，HLB-SIMPLE联盟正在采取协调一致的方法来评估成本和 这些干预措施的成本效益。目前，资金是通过卫生与公众服务部的个人拨款提供的- 简单联盟，开发一套标准化工具，并收集六项中的四项的成本数据 参与站点。本补编将通过三个具体目标在这些活动的基础上进一步优化 NHLBI投资HLB-SIMPLE联盟基础设施在经济领域的科学影响 评估。在目标1中，我们将把我们协调一致的成本数据收集工作扩大到其余两个地点， 从而增强了我们调查结果的概括性和相关性。在目标2中，我们将创建一个可访问的 供寻求评估成本和成本效益的其他研究人员和调查人员使用的工具包 艾滋病毒/非传染性疾病综合护理。我们还将使用HLB-SIMPLE研究来“压力测试”和改进这个工具包， 将我们的发现公开提供给科学界和实施界。通过这种方式，我们将 确保通过HLB-Simple Experience学到的经验教训为更广泛的决策者提供信息 并促进对实施艾滋病毒/非传染性疾病综合护理的经济学的科学理解。在目标3中，我们 将制定一项为期一年的能力建设计划，最终在我们非洲的一个地点举行为期十天的峰会， 为了确保我们的非洲合作者利用HLB-SIMPLE联盟的经验作为跳板 成为这一新兴研究利基市场的领导者。圆满完成本管理的目标 因此，补充将使我们能够充分利用HLB-Simple Alliance的基础设施 改进对艾滋病毒/非传染性疾病综合护理的经济评估--在联盟内和(由我们的非洲人领导) 合作伙伴)在整个科学界。

Project Summary Low- and middle-income countries (LMICs) are facing an escalating burden of heart, lung, blood, and sleep (HLBS) disorders among people with HIV (PWH). In implementing interventions to ameliorate this burden, evaluation of cost, cost-effectiveness, and budget impact are increasingly important. Furthermore, implementing integrated care in LMICs involves unique economic considerations. For example, launching such interventions often involves major up-front costs (e.g., reorganizing systems of care, investing in technological or other infrastructure), whereas health benefits are more uncertain and only accrue over time. Similarly, it is difficult to compare the costs of integrated care against an “unintegrated” standard of care in which non- communicable diseases (NCDs) such as hypertension are often not diagnosed or treated at all. The HLB- SIMPLe Alliance is a highly collaborative consortium that is evaluating the implementation of diverse and culturally relevant interventions for hypertension control among PWH in six sub-Saharan African countries (South Africa, Botswana, Zambia, Mozambique, Uganda, and Nigeria). Led by a designated Cost- Effectiveness Subgroup, the HLB-SIMPLe Alliance is taking a coordinated approach to evaluating the cost and cost-effectiveness of these interventions. Currently, funding exists through the individual grants of the HLB- SIMPLe Alliance to develop a set of standardized instruments and to collect data on costs in four of the six participating sites. This Supplement will build on these activities through three Specific Aims to optimize the scientific impact of NHLBI’s investment in the HLB-SIMPLe Alliance infrastructure in the field of economic evaluation. In Aim 1, we will expand our coordinated cost data collection efforts to the two remaining sites, thereby enhancing the generalizability and relevance of our findings. In Aim 2, we will create an accessible toolkit for use by other researchers and investigators seeking to evaluate the costs and cost-effectiveness of integrated HIV/NCD care. We will also use the HLB-SIMPLe studies to “pressure-test” and refine this toolkit, making our findings openly available to both scientific and implementation communities. In this way, we will ensure that lessons learned through the HLB-SIMPLe experience inform a broader array of decision-makers and advance scientific understanding of the economics of implementing integrated HIV/NCD care. In Aim 3, we will develop a year-long capacity building program, culminating in a ten-day summit in one of our African sites, to ensure that our African collaborators use the experience of the HLB-SIMPLe Alliance as a springboard to become leaders in this emerging research niche. Successful completion of the Aims in this Administrative Supplement will therefore enable us to take full advantage of the infrastructure of the HLB-SIMPLe Alliance to improve economic evaluation of integrated HIV/NCD care – both within the Alliance and (led by our African partners) throughout the scientific community as a whole.