Optimal Medication Dispensing for People Living with HIV with and without Other Chronic Diseases in Zambia: A Mathematical Model

赞比亚患有或不患有其他慢性疾病的艾滋病毒感染者的最佳药物分配：数学模型

• 批准号: 10448273
• 负责人: Youngji Jo
• 金额: $ 7.68万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448273
• 关键词: AIDS/HIV problem; Address; Age; Award; Behavior; Boston; COVID-19; Caring; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Congestive; Costs and Benefits; Crowding; Data; Data Analyses; Data Set; Diabetes Mellitus; Disease; Disease model; Environment; Epidemiology; Equilibrium; Event; Failure; Feedback; Frequencies; Genetic; Grant; HIV; Health; Health Status; Health system; Hospitals; Impairment; Individual; Infection; Intervention; Life; Measurable; Measurement; Medical; Medical Records; Mentors; Modeling; Outcome; Patient Care; Patient Preferences; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Policies; Population; Prevalence; Probability; Research; Research Training; Resource-limited setting; Resources; Service delivery model; Services; System; Testing; Time; Triage; Tuberculosis; Universities; Viral Load result; Visit; Wait Time; Work; Writing; Zambia; adverse outcome; antiretroviral therapy; base; care seeking; combat; comorbidity; cost; cost effectiveness; density; design; disease transmission; experience; follow-up; implementation evaluation; implementation strategy; improved; indexing; mathematical model; multidisciplinary; population health; profiles in patients; program costs; response; service delivery; sex; success

PROJECT SUMMARY In the current era of universal antiretroviral treatment (ART), health systems have the challenge of optimizing care for a growing number of diverse groups of people living with HIV and on ART who are also on chronic, life-long treatment for non-communicable diseases (NCDs). Differentiated service delivery (DSD) was developed as a means to combat suboptimal long-term retention on ART and increase the efficiency of resource utilization by simplifying and adapting care along the cascade, guided by patient preferences and needs, while reducing unnecessary burdens on individuals and the health system. Much remains to be understood, however, about whether DSD models will work for integrated service delivery for multiple conditions and how to find the optimal DSD model for specific populations and health systems. Using a large patient dataset of routinely collected medical records in Zambia, I propose to create a dynamic microsimulation model of disease and service delivery – focusing on HIV with and without other chronic diseases such as diabetes – to identify the potential benefits and costs of an optimal medication dispensing strategy. I expect that the cost-effectiveness of alternative drug dispensing strategies will be a function of service volume, patient outcomes, unit costs, and probability of congestion within clinics. This research will directly inform policy questions relating to how DSD models should be implemented to improve population health outcomes and program cost-effectiveness. Aims 1 and 2 will construct HIV service delivery indices of intensity, capacity, density, and frequency, assess distributions by patient/facility groups, and evaluate economies of scale of drug dispensing strategies for HIV with and without other chronic diseases such as diabetes. I will build a model to quantify the extent of service capacity and utilization increase using an integrated and multi-month drug dispensing strategy for HIV and diabetes, based on the proportion of stable/comorbid patients, unit time/cost per service, and clinic capacity. Aim 3 will project the long-term impact and cost-effectiveness of an integrated drug dispensing strategy for HIV with and without other chronic diseases. My model will estimate whether and to what extent service integration and multi-month drug dispensing can change total treatment initiation and retention in a clinic and how that may in turn change the probability of clinic congestion, unit costs, treatment retention/service quality, and cost effectiveness. The primary research environment, Boston University Medical Campus, will contribute to the success of the proposed project, as it provides rich, multidisciplinary institutional resources, including a strong commitment to research and training and ample departmental facilities and resources. I have access to the necessary resources and data to complete the proposed research. Through this mentored research training award, I will gain expertise in infectious diseases transmission modeling and cost-effectiveness, and experience of successful grant writing.

项目摘要 在当前通用抗逆转录病毒治疗（ART）的时代，卫生系统面临优化的挑战 照顾越来越多的艾滋病毒和艺术的潜水员群体，他们也正在慢性病中， 终身治疗非通信疾病（NCD）。差异化服务交付（DSD）是 作为对抗艺术的长期保留的一种手段，并提高了 通过简化和调整级联护理的资源利用，在患者偏好和 需求，同时减少对个人和卫生系统的不必要的伯恩斯。还有很多 但是，了解DSD模型是否适用于多个的集成服务交付 条件以及如何为特定人群和卫生系统找到最佳的DSD模型。使用大 我建议在赞比亚定期收集病历的病人数据集，以创建动态微观仿真 疾病和服务的模型 - 专注于有和没有其他慢性疾病的艾滋病毒，例如 糖尿病 - 确定最佳药物分配策略的潜在收益和成本。我希望 替代药物分配策略的成本效益将是服务量的函数，患者 诊所内的结果，单位成本和拥塞的可能性。这项研究将直接告知政策 有关如何实施DSD模型以改善人口健康成果和 计划成本效益。目标1和2将构建强度，容量， 密度和频率，患者/设施组的评估分布，并评估药物规模的经济 患有或没有其他慢性疾病（例如糖尿病）的艾滋病毒的分配策略。我将建立一个模型 使用集成和多个月的药物量化服务能力和利用率的增加程度 根据稳定/合并症患者的比例，单位时间/成本，针对艾滋病毒和糖尿病的分配策略 每个服务和诊所能力。 AIM 3将展示综合的长期影响和成本效益 患有和没有其他慢性疾病的艾滋病毒的药物分配策略。我的模型将估计是否以及 服务整合和多个月药物分配在多大程度上可以改变总治疗计划，并且 保留在诊所中，这可能如何改变诊所拥塞，单位成本，治疗的可能性 保留/服务质量和成本效益。波士顿大学医学的主要研究环境 校园将为拟议项目的成功做出贡献，因为它提供了丰富的多学科机构 资源，包括对研究和培训的坚定承诺以及足够的部门设施以及 资源。我可以访问必要的资源和数据以完成拟议的研究。通过 这项指导的研究培训奖，我将获得传染病传播建模和 成本效益和成功赠款写作的经验。

项目成果

Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea.

• DOI: 10.4178/epih.e2022034
• 发表时间: 2022
• 期刊: Epidemiology and health
• 影响因子: 3.8
• 作者: Jo Y;Kim SB;Radnaabaatar M;Huh K;Yoo JH;Peck KR;Park H;Jung J
• 通讯作者: Jung J

Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia.

• DOI: 10.1371/journal.pone.0280748
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Jo, Youngji;Jamieson, Lise;Phiri, Bevis;Grimsrud, Anna;Mwansa, Muya;Shakwelele, Hilda;Haimbe, Prudence;Mukumbwa-Mwenechanya, Mpande;Mulenga, Priscilla Lumano;Nichols, Brooke E.;Rosen, Sydney
• 通讯作者: Rosen, Sydney

Optimal Social Distancing Policy for COVID-19 Control in Korea: A Model-Based Analysis.

• DOI: 10.3346/jkms.2022.37.e189
• 发表时间: 2022-06-13
• 期刊: JOURNAL OF KOREAN MEDICAL SCIENCE
• 影响因子: 4.5
• 作者: Youngji, Jo;Sourya, Shrestha;Munkhzul, Radnaabaatar;Hojun, Park;Jaehun, Jung
• 通讯作者: Jaehun, Jung