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，发展中国家在向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、二线和三线抗逆转录病毒治疗的费用以及扩大护理的影响仍然存在很大的不确定性。随着艾滋病毒流行的持续增长，这些问题需要进行批判性分析。 2004 年，NIAID 资助我们的研究小组开发“预防 AlDS 并发症的成本效益 (CEPAC) 国际”模型，该模型对南非艾滋病毒疾病的自然史、临床管理、结果和成本进行计算机模拟，Cote迪瓦和印度。目前的项目已经出版了 16 种出版物，其中包括一篇被广泛引用的《新英格兰医学杂志》文章，以及另外 9 份在前 3 年提交或起草的手稿。在这个竞争性的延续中，我们请求支持开发第二代 CEPAC 国际模型。这个新模型将反映对 HIV 和 AlDS 流行病学、治疗效果、对结核病传播的影响以及护理成本效益的最新了解。当前提案的三个具体目标是： 1) 完善 CEPAC-国际模型对关键患者和人群水平影响的描述。这将包括时间错开的多个进入队列、人与人之间的艾滋病毒传播和结核病传播、长期抗逆转录病毒疗法相关的毒性和合并症，并完善抗逆转录病毒药物耐药性的方法。 2) 预测发展中国家艾滋病毒护理的不同患者层面治疗策略的临床结果、成本和成本效益； 3) 确定发展中国家人口层面的最佳艾滋病毒和艾滋病治疗和预防策略。组成的研究团队在发表和传播研究结果方面拥有丰富的记录，这些研究结果为美国和国际上艾滋病毒护理和实践指南制定的优先事项设定提供了信息。为了增强团队的建模能力，团队中增加了在艾滋病毒/结核病合并感染、传播动力学以及传染病建模方面具有丰富经验的熟练研究人员。通过继续这个多学科团队已经取得的重大进展，并实现上述具体目标，拟议的研究将解决发展中国家的提供者和政策制定者未来面临的最关键的艾滋病毒临床政策和成本效益问题几年。公共卫生相关性 尽管全球范围内最近在向发展中国家提供艾滋病毒治疗和护理方面取得了进展，但在全面实施这些计划以及了解全球不同艾滋病毒护理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适用的方法来研究艾滋病毒干预措施、预测其结果并强调未来研究的重要领域。我们计划的灵活性使我们的团队能够从多个角度调查问题，从而深入了解可能无法通过大规模临床试验在现实环境中进行测试的场景。