Optimizing HIV Care in Less Developed Countries

优化欠发达国家的艾滋病毒护理

• 批准号: 8731681
• 负责人: Kenneth Alan Freedberg
• 金额: $ 143.58万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8731681
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa; Asia; Award; Bedside Testings; Behavioral; Benchmarking; Brazil; Budgets; Caring; Clinical; Clinical Management; Collaborations; Communities; Comorbidity; Computer Simulation; Country; Data; Detection; Developing Countries; Development; Disease; Economics; Ensure; Environment; Evaluation; Funding; Guidelines; HIV; Hepatitis B; Hepatitis C virus; Heterogeneity; Hypertension; India; Individual; Interdisciplinary Study; International; Intervention; Investigation; Journals; Laboratories; Latin America; Life Expectancy; Methodology; Methods; Modeling; Monitor; National Institute of Allergy and Infectious Disease; Natural History; Online Systems; Outcome; Paper; Patients; Peer Review; Performance; Persons; Policies; Policy Maker; Prevention; Provider; Public Health; Publishing; Regimen; Research; Research Personnel; Resources; Role; South Africa; Structure; Technical Expertise; Technology; Time; Uncertainty; United States; antiretroviral therapy; burden of illness; clinical efficacy; cost; cost effective; cost effectiveness; economic impact; global environment; improved; innovation; insight; multidisciplinary; new technology; novel; novel strategies; pandemic disease; prevent; public health relevance; scale up; screening; transmission process; treatment program

Project Summary/Abstract The past decade has seen tremendous progress in the delivery of treatment of HIV-infected individuals worldwide. Better antiretroviral therapy (ART), improved laboratory monitoring, and evidence of ART as prevention have led to the possibility of beginning to reverse the AIDS pandemic. At the same time, limited resources worldwide have tempered the ability of the international community to optimally utilize these proven interventions. In 2004 and in 2008, NIAID awarded our research group funding to develop and expand the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer simulation of the natural history, clinical management, outcomes, and cost-effectiveness of HIV treatment in 3 resource- limited settings: South Africa, C¿te d'lvoire, and India. In the last 5-year cycle of the project, this collaboration produced more than 105 original papers in peer-reviewed journals. In this continuation, we propose to further expand the CEPAC-I Model to reflect important developments in HIV/AIDS, and to address several of the most pressing questions in HIV care. We have three specific aims: Specific Aim 1: To examine the optimal packages of HIV care - ART initiation, monitoring strategies including use of point-of-care tests, and regimen sequencing - given varying resource constraints in South Africa, C¿te d'Ivoire, India, and Brazil. We will create a new web-based 'metamodel' structure to allow clinical policy makers in other countries to access the capabilities of the CEPAC-I Model. Specific Aim 2: To define the benchmarks of clinical efficacy and cost by which new technologies - including long-acting ART and strategies for HIV eradication - may become viable and cost-effective options. We will perform analyses to establish performance requirements for new HIV treatments in resource-limited settings to be cost-effective. Novel modeling methods will incorporate patient heterogeneity as well as expanded probabilistic sensitivity analysis. Specific Aim 3: To project clinical outcomes, cost, and cost-effectiveness of detection and treatment for major co-morbidities in people with HIV, including hepatitis B and C viruses, TB, and hypertension. We will assess the cost-effectiveness of merging HIV care with screening and treatment for other common diseases in people with HIV. With new approaches to costing and budget impact analysis, we will assess the affordability of broadening HIV treatment programs. The assembled internationally-recognized, multidisciplinary research team has a lengthy record of disseminating findings to inform HIV care and guidelines, both in the US and internationally. To expand the project scope, we have added investigators from Brazil, the most HIV-affected country in Latin America. By leveraging the team's progress over the past 9 years and accomplishing the aims above, the proposed studies will answer many critical HIV clinical and policy questions facing the global HIV community.

项目概要/摘要 过去十年，艾滋病毒感染者的治疗取得了巨大进展 更好的抗逆转录病毒治疗 (ART)、改进的实验室监测以及 ART 的证据 与此同时，预防工作导致扭转艾滋病流行的可能性也有限。 世界各地的资源增强了国际社会最佳利用这些经过验证的资源的能力 2004 年和 2008 年，NIAID 为我们的研究小组提供了资金，以开发和扩大干预措施。 国际预防艾滋病并发症 (CEPAC-I) 模型的计算机模拟 三种资源中的艾滋病毒治疗的自然史、临床管理、结果和成本效益- 有限设置：南非，C¿特迪瓦和印度 在该项目的最后 5 年周期中，这种合作。 在同行评审期刊上发表了超过 105 篇原创论文。 扩展 CEPAC-I 模型以反映艾滋病毒/艾滋病方面的重要进展，并解决几个最重要的问题 艾滋病毒护理方面的紧迫问题我们有三个具体目标： 具体目标 1：检查最佳的 HIV 护理方案 - ART 启动、监测策略，包括 使用现场检测和治疗方案排序 - 考虑到南非不同的资源限制，C¿特 我们将创建一个新的基于网络的“元模型”结构，以便临床决策者能够进行决策。 在其他国家/地区访问 CEPAC-I 模型的功能。 具体目标 2：定义新技术的临床疗效和成本基准 - 包括 长效抗逆转录病毒治疗和根除艾滋病毒战略可能成为可行且具有成本效益的选择。 进行分析以确定在资源有限的环境中新的艾滋病毒治疗的性能要求 新颖的建模方法将纳入患者的异质性并进行扩展。 概率敏感性分析。 具体目标 3：预测重大疾病检测和治疗的临床结果、成本和成本效益 我们将评估艾滋病毒感染者的合并症，包括乙型和丙型肝炎病毒、结核病和高血压。 将艾滋病毒护理与其他常见疾病的筛查和治疗相结合的成本效益 通过新的成本计算和预算影响分析方法，我们将评估艾滋病毒的承受能力。 扩大艾滋病毒治疗计划。 组建的国际公认的多学科研究团队拥有长期的记录 在美国和国际上传播研究结果，为艾滋病毒护理和指南提供信息。 在项目范围内，我们增加了来自拉丁美洲受艾滋病毒影响最严重的国家巴西的调查人员。 利用团队过去 9 年的进展并实现上述目标，拟议的研究 将回答全球艾滋病毒界面临的许多关键艾滋病毒临床和政策问题。