Tobacco Use and Cessation, HIV, and TB in South Africa: Clinical and Economic Outcomes

项目摘要 全球卫生组织呼吁将烟草控制纳入艾滋病毒和结核病（TB） 应答烟草使用损害艾滋病毒感染者的健康结果，包括增加结核病的风险 以及心血管疾病和癌症等非传染性疾病。如何最有效地和 有效地将烟草控制纳入艾滋病毒和结核病护理仍不清楚;资源限制需要 深思熟虑的循证规划。确定哪些干预措施最有效和最具成本效益， 以及如何将联合收割机输送方法组合以获得最佳结果，对于告知临床 指南这需要了解各种干预措施的好处和成本，这些措施的成本- 有效性建模是专门为解决。 该提案的总体目标是促进以循证方法作出有关 在低收入和中等收入国家，针对重叠的烟草、艾滋病毒和结核病流行的综合护理和服务 中低收入国家。低收入中等收入国家的烟草使用和戒烟行为可能与高收入国家不同。 国家，可以影响干预措施的有效性。在本提案中，我们将重点关注南非， 烟草、艾滋病和结核病流行相互冲突的国家。我们的研究计划包括： 烟草、艾滋病毒和结核病的模拟模型;用行为、临床和成本数据对模型进行参数化 来自南非社区人口队列以及其他数据库和研究; 与艾滋病毒感染者烟草使用和戒烟相关的临床和经济结果;以及 对戒烟干预措施进行基于模型的成本效益分析，包括 结合其他艾滋病毒和结核病护理干预措施。 该提案汇集了国际公认的、与该提案相辅相成的领域的专家 项目，包括临床政策相关的艾滋病毒和结核病模拟建模，健康行为，烟草治疗 干预措施，艾滋病毒和合并症在南非的流行病学。研究者和试验机构 有着高效合作的历史。这一创新模式将率先将烟草、 艾滋病和肺结核。这些方法对于解决成本问题非常重要和关键- 将戒烟与艾滋病毒和结核病护理相结合的有效性和政策。模型结构将 使今后能够在其他环境中对戒烟干预措施进行分析， 与政策相关的临床和卫生经济分析框架。

PROJECT SUMMARY Global health organizations have called for integrating tobacco control into HIV and tuberculosis (TB) responses. Tobacco use worsens health outcomes of people with HIV, including conferring higher risks of TB and of noncommunicable diseases such as cardiovascular disease and cancer. How to most effectively and efficiently incorporate tobacco control into HIV and TB care remains unclear; resource constraints necessitate thoughtful and evidence-based planning. Determining which interventions are most effective and cost-effective, and how to combine delivery approaches for optimal outcomes, is critically important for informing clinical guidelines. This requires understanding the benefits and costs of various interventions, which cost- effectiveness modeling is specifically designed to address. The overall goal of this proposal is to promote an evidence-based approach to decisions surrounding the integrated care and services for the overlapping tobacco, HIV, and TB epidemics in low- and middle-income countries (LMICs). Tobacco use and cessation behaviors in LMICs may differ from those in high-income countries and can influence the effectiveness of interventions. In this proposal, we will focus on South Africa, a country with colliding tobacco, HIV, and TB epidemics. Our research plan includes: developing an integrated simulation model of tobacco, HIV, and TB; parameterizing the model with behavioral, clinical, and cost data from a community-based population cohort in South Africa and from other databases and studies; projecting clinical and economic outcomes associated with tobacco use and cessation among people with HIV; and conducting model-based cost-effectiveness analysis of tobacco cessation interventions, including those combined with other HIV and TB care interventions. This proposal brings together internationally recognized experts in fields that are complementary for the project, including clinical policy-relevant HIV and TB simulation modeling, health behaviors, tobacco treatment interventions, and epidemiology of HIV and comorbidities in South Africa. The investigators and institutions have a history of highly productive collaboration. The innovative model will be the first to integrate tobacco, HIV, and TB. The methods are highly significant and crucial for addressing questions around cost- effectiveness and policies for integrating tobacco cessation with HIV and TB care. The model structure will enable future analyses of tobacco cessation interventions in other settings, establishing a broad, durable framework for policy-relevant clinical and health economic analyses.