Novel approaches to the design and evaluation of combination HIV prevention

设计和评估艾滋病毒联合预防的新方法

• 批准号: 8729655
• 负责人: A. DAVID PALTIEL
• 金额: $ 67.98万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-25 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8729655
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Budgets; Caring; Clinical; Clinical Management; Collaborations; Computer Simulation; Cost Effectiveness Analysis; Detection; Development; Disease; Epidemic; Epidemiology; Equilibrium; Evaluation; Face; Frequencies; Guidelines; HIV; Health Promotion; Hot Spot; Human immunodeficiency virus test; Incentives; Intervention; Magic; Manuscripts; Measures; Modeling; Outcome; Patient Care; Peer Review; Policies; Population; Prevention; Prevention program; Prevention strategy; Preventive Intervention; Prophylactic treatment; Publishing; Research; Resource Allocation; Running; Target Populations; Taxonomy; Therapeutic; Thinking; Translating; United States; Work; antiretroviral therapy; behavior change; cost; cost effective; cost effectiveness; design; evidence base; financial incentive; novel; novel strategies; prevent; prevention service; programs; public health relevance; screening; transmission process

DESCRIPTION (provided by applicant): HIV prevention works but no single intervention alone will be enough to stop the HIV epidemic in the United States. In the absence of a "magic bullet", the challenge is to identify specific program bundles and high-value targets that will squeeze the greatest possible benefit out of every prevention dollar. In 1994, our research group launched the "Cost-effectiveness of Preventing AIDS Complications" (or CEPAC) Collaboration, to develop a computer simulation of the clinical management, outcomes, and costs of HIV disease. We have employed the CEPAC Model to evaluate the clinical impact and cost-effectiveness of the most important developments in HIV detection, therapeutics, and prevention. In this application, we propose to use the CEPAC Model to advance three novel ways of thinking about HIV prevention program design and evaluation: viewing HIV prevention in terms of policy bundles; looking beyond program cost-effectiveness to program affordability; and designing financial incentives that translate into better long-term HIV outcomes. Our specific aims are: 1) To develop a taxonomy that characterizes the synergies and offsets that are created when prevention programs are bundled alongside one another. We will leverage the CEPAC Model to explore how the magnitude of these synergies/offsets varies with a policy bundle's scale and target population. To illustrate the usefulness of our approach, we will evaluate the cost-effectiveness of early antiretroviral therapy and HIV pre-exposure prophylaxis when used in combination with one another. 2) To conduct budget impact analysis alongside cost-effectiveness analysis. We will capitalize on the CEPAC Model's ability to assign specific costs to specific payers for specific populations, across the spectrum of HIV screening, treatment, and prevention services. To illustrate the usefulness of our approach, we will assess both the cost-effectiveness and budget impact of high-frequency HIV testing in select "hot spot" populations. 3) To develop a framework for categorizing and measuring the impact of financial incentives for plugging the leaks in the continuum of HIV care. We will exploit the CEPAC Model's capacity to translate/extrapolate short-run behavior change into downstream clinical and epidemic outcomes. To illustrate the usefulness of our approach, we will optimize the design of alternative incentive bundles aimed at achieving the treatment and prevention targets of the National HIV/AIDS Strategy. The broad objective that guides our research is to promote a reasoned approach to resource allocation in HIV. Our team has a proven record of disseminating findings that influence national HIV/AIDS policy. The current research plan advances the state of the art in evidence-based HIV prevention program design and evaluation.

描述（由申请人提供）：艾滋病毒预防是有效的，但单独的干预措施不足以阻止美国艾滋病毒的流行。在缺乏“灵丹妙药”的情况下，面临的挑战是确定具体的计划包和高价值目标，从而从每一笔预防资金中获得最大可能的效益。 1994 年，我们的研究小组启动了“预防艾滋病并发症的成本效益”（或 CEPAC）合作，开发艾滋病毒疾病临床管理、结果和成本的计算机模拟。我们采用 CEPAC 模型来评估 HIV 检测、治疗和预防领域最重要发展的临床影响和成本效益。在此应用中，我们建议使用 CEPAC 模型来推进三种关于艾滋病毒预防计划设计和评估的新颖思维方式：从政策组合的角度看待艾滋病毒预防；超越项目成本效益，关注项目负担能力；设计经济激励措施，以转化为更好的长期艾滋病毒结果。我们的具体目标是： 1) 开发一种分类法，描述预防计划相互捆绑时产生的协同作用和抵消作用。我们将利用 CEPAC 模型来探讨这些协同效应/抵消的幅度如何随政策组合的规模和目标人群而变化。为了说明我们方法的有用性，我们将评估早期抗逆转录病毒治疗和艾滋病毒暴露前预防联合使用时的成本效益。 2) 进行预算影响分析和成本效益分析。我们将利用 CEPAC 模型的能力，在艾滋病毒筛查、治疗和预防服务的各个方面，将特定成本分配给特定人群的特定付款人。为了说明我们方法的实用性，我们将评估在选定的“热点”人群中进行高频艾滋病毒检测的成本效益和预算影响。 3) 制定一个框架，对财政激励措施的影响进行分类和衡量，以堵住艾滋病毒护理连续性的漏洞。我们将利用 CEPAC 模型的能力将短期行为变化转化/外推为下游临床和流行病结果。为了说明我们方法的实用性，我们将优化替代激励措施的设计，旨在实现国家艾滋病毒/艾滋病战略的治疗和预防目标。指导我们研究的总体目标是促进艾滋病毒资源分配的合理方法。我们的团队在传播影响国家艾滋病毒/艾滋病政策的研究结果方面有着良好的记录。当前的研究计划推进了基于证据的艾滋病毒预防计划设计和评估的最先进水平。