Optimizing HIV Care in Less Developed Countries

优化欠发达国家的艾滋病毒护理

• 批准号: 7924291
• 负责人: Kenneth Alan Freedberg
• 金额: $ 74.87万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-22 至 2012-09-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7924291
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Adopted; Anti-Retroviral Agents; Antiretroviral drug resistance; Area; Award; Cardiovascular Diseases; Caring; Chronic; Clinical; Clinical Management; Clinical Trials; Computer Simulation; Country; Data Analyses; Decision Making; Developed Countries; Developing Countries; Development; Diabetes Mellitus; Disease; Epidemic; Epidemiology; Face; Federal Government; Funding; Future; Generations; Goals; Grant; Guidelines; HIV; Health; Health Personnel; Healthcare; India; Individual; Infection; International; Intervention; Journals; Laboratories; Life; Lipodystrophy; Manuscripts; Medicine; Modeling; Morbidity - disease rate; National Institute of Allergy and Infectious Disease; Natural History; Neuropathy; New England; Outcome; Patients; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Practice Guidelines; Prevention; Prevention strategy; Preventive; Provider; Publications; Publishing; Quality Control; Research; Research Personnel; Resistance; Resources; Simulate; South Africa; Stavudine; Structure; Tenofovir; Testing; Time; Toxic effect; Treatment Efficacy; Treatment Protocols; Uncertainty; antiretroviral therapy; base; clinical care; cohort; cost; cost effectiveness; experience; flexibility; follow-up; infectious disease model; innovation; insight; isoniazid; mortality; multidisciplinary; patient population; prevent; programs; public health relevance; transmission process; treatment strategy

DESCRIPTION (provided by applicant): The past several years have seen major progress in the delivery of treatment and care to HIV-infected people in the developing world. However, substantial uncertainty persists regarding optimal treatment strategies, the cost of second- and third-line antiretroviral treatment, and the impact of expanded care. As the HIV epidemic continues to grow, these problems require critical analysis. In 2004, NIAID awarded our research group funding to develop the "Cost-effectiveness of Preventing AlDS Complications (CEPAC) International" Model, a computer simulation of the natural history, clinical management, outcomes, and costs of HIV disease in South Africa, Cote d'lvoire, and India. The current project has produced 16 publications, including a widely cited New England Journal of Medicine article, and another 9 submitted or draft manuscripts in its first 3 years. In this competing continuation, we request support to develop a 2nd generation CEPAC-International Model. This new model will reflect the most current understanding of HIV and AlDS epidemiology, treatment efficacy, impact on TB transmission and cost-effectiveness of care. The three specific aims of the current proposal are: 1) To refine the CEPAC-International Model's portrayal of critical patient- and population-level effects. This will include multiple entry cohorts staggered in time, person-to-person HIV transmission and TB transmission, long-term ART-related toxicities and co-morbidities, and to refine the approach to antiretroviral drug resistance. 2) To project clinical outcomes, cost, and cost-effectiveness of different patient-level treatment strategies for HIV care in developing countries; and 3) To identify optimal population-level HIV and AIDS treatment and prevention strategies in developing countries. The assembled research team has an extensive record of publishing and disseminating findings that inform priority setting in HIV care and practice guideline development, in the US and internationally. To augment the team's modeling capacity, skilled investigators with experience in HIV/TB co-infection, transmission dynamics as well as infectious disease modeling have been added to the team. By continuing the major progress already made by this multidisciplinary team, and accomplishing the specific aims described above, the proposed studies will address the most crucial HIV clinical policy and cost-effectiveness questions that will face providers and policy-makers in developing countries over the next several years. PUBLIC HEALTH RELEVANCE Despite recent progress globally to deliver HIV treatment and care to developing countries, major challenges remain in fully implementing these programs and understanding the clinical outcomes and cost-effectiveness of different strategies for HIV care worldwide. The CEPAC-International Model provides an inexpensive yet broadly applicable way of studying HIV interventions, projecting their outcomes, and highlighting important areas for future research. The flexibility of our program allows our team to investigate problems from several angles, providing insight into scenarios that may not be feasible to test in real-life settings through large-scale clinical trials.

描述（由申请人提供）：过去几年，在向发展中国家的艾滋病毒感染者提供治疗和护理方面取得了重大进展。然而，关于最佳治疗策略，第二线抗逆转录病毒治疗的成本以及扩展护理的影响，存在实质性不确定性。随着HIV流行的发展，这些问题需要进行批判性分析。 2004年，NIAID授予了我们的研究小组资金，以发展“预防ALDS并发症的成本效益（CEPAC）国际模型”，这是对自然史，临床管理，临床管理，成果和HIV疾病成本的计算机模拟，南非，科特·德·d'lvoire和印度。当前的项目已经制作了16个出版物，其中包括一篇广泛引用的新英格兰医学杂志文章，并在头三年中提交了9个手稿或草案。在这种竞争的延续中，我们要求支持第二代CEPAC内部模型。这个新模型将反映出对艾滋病毒和ALDS流行病学，治疗疗效，对结核病传播的影响以及护理成本效益的最新理解。当前提案的三个特定目的是：1）完善CEPAC内部模型对关键患者和人口水平效应的描述。这将包括随着时间流逝的多个入境人群，人与人的HIV传播和TB传播，长期与ART相关的毒性和合并症，以及完善抗逆转录病毒耐药性的方法。 2）在发展中国家的不同患者水平治疗策略中，预测临床结果，成本和成本效益； 3）确定发展中国家的最佳人群艾滋病毒和艾滋病治疗和预防策略。组装研究团队在美国和国际上的艾滋病毒护理和实践指南开发方面的优先设置为优先设置提供了发布和传播发现的广泛记录。为了增强团队的建模能力，熟练的研究人员具有艾滋病毒/结核病共同感染的经验，传播动力学以及传染病建模已增加。通过继续该多学科团队已经取得的重大进展，并实现上述具体目标，拟议的研究将解决最关键的HIV临床政策和成本效益问题，这些问题将在未来几年内面临发展中国家的提供者和决策者。尽管最近在全球范围内为发展中国家提供艾滋病毒治疗和护理，但公共卫生的相关性仍在充分实施这些计划并了解全球不同策略的临床结果和成本效益方面仍然存在重大挑战。 CEPAC国际模型提供了一种廉价但广泛的研究艾滋病毒干预措施，预测其结果并突出未来研究的重要领域的方式。我们计划的灵活性使我们的团队能够从几个角度调查问题，从而深入了解这些方案可能是通过大规模临床试验在现实生活环境中进行测试的情况。