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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要在当前普遍抗逆转录病毒治疗 (ART) 的时代，卫生系统面临着优化的挑战为越来越多接受抗逆转录病毒疗法的不同人群提供护理，这些人还接受慢性、非传染性疾病（NCD）的终身治疗是有差别的服务提供（DSD）。开发作为一种手段来对抗 ART 的长期保留不佳并提高治疗效率以患者偏好为指导，通过简化和调整级联护理来利用资源的需求，同时减少个人和卫生系统不必要的负担。然而，人们了解 DSD 模型是否适用于多种服务的综合服务交付条件以及如何使用大型数据找到针对特定人群和卫生系统的最佳 DSD 模型。赞比亚定期收集的医疗记录的患者数据集，我建议创建一个动态微观模拟疾病和服务提供模式——重点关注患有或不患有其他慢性疾病的艾滋病毒，例如糖尿病——我期望确定药物配药策略的潜在最佳效益和成本。替代药物配药策略的成本效益将是服务量、患者数量的函数这项研究将直接为政策提供信息。有关如何实施 DSD 模型以改善人口健康结果的问题以及计划的目标 1 和 2 将构建艾滋病毒服务提供强度、能力、密度和频率，评估患者/设施组的分布，并评估药物的规模经济我将建立一个模型来研究患有或不患有糖尿病等其他慢性疾病的艾滋病毒的分配策略。使用综合的多月药物来量化服务能力和利用率增加的程度 HIV 和糖尿病的配药策略，基于稳定/共病患者的比例、单位时间/成本目标 3 将预测综合服务的长期影响和成本效益。我的模型将评估是否存在和不存在其他慢性疾病的艾滋病毒配药策略。服务整合和多月药物配发可以在多大程度上改变总体治疗开始和保留在诊所，以及这如何反过来改变诊所拥挤的可能性、单位成本、治疗保留/服务质量和成本效益主要研究环境，波士顿大学医学院。校园，将有助于拟议项目的成功，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充足的部门设施和我可以获得必要的资源和数据来完成拟议的研究。通过这个指导研究培训奖，我将获得传染病传播模型方面的专业知识和成本效益和成功撰写赠款的经验。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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