Improving allocation of limited HIV prevention and treatment resources in Zambia

改善赞比亚有限的艾滋病毒预防和治疗资源的分配

• 批准号: 9230869
• 负责人: Kristin Marie Wall
• 金额: $ 12.81万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-23 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9230869
• 关键词: AIDS prevention; AIDS/HIV problem; Advocacy; Africa; Africa South of the Sahara; Algorithms; Anti-Retroviral Agents; Area; Attitude; Biomedical Engineering; Budgets; Centers for Disease Control and Prevention (U.S.); Communities; Competence; Cost effectiveness research; Counseling; Country; Couples; Data; Decision Making; Development; Disease model; Doctor of Philosophy; Drops; Economics; Effectiveness of Interventions; Epidemic; Epidemiologic Methods; Epidemiology; Ethics; Evidence based intervention; Faculty; Family Planning; Fellowship; Foundations; Funding; Government; Grant; Guidelines; HIV; HIV Infections; Health; Health Benefit; Health Personnel; Health Policy; Human; Human immunodeficiency virus test; Incidence; Individual; Infection; Instruction; International; Intervention; Interview; Investigation; Light; Link; Male Circumcision; Mathematics; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; NIH Office of AIDS Research; National Institute of Mental Health; Outcome; Output; Patients; Policies; Policy Developments; Politics; Population Intervention; Population Programs; Postdoctoral Fellow; Prevention; Prevention program; Preventive Intervention; Principal Investigator; Production; Recording of previous events; Records; Research; Research Assistant; Research Personnel; Research Priority; Resource Allocation; Resources; Risk; Rwanda; Self-Direction; Services; Strategic Planning; Structure; Technology; Testing; Therapeutic; Time; Training; Translating; Translations; Treatment outcome; United States; United States National Institutes of Health; Universities; Vertical Disease Transmission; Work; Zambia; base; cost; cost effectiveness; cost-effectiveness ratio; economic evaluation; evidence base; experience; fighting; formative assessment; health economics; health practice; improved; infectious disease model; innovation; intervention effect; mathematical model; member; multidisciplinary; pre-exposure prophylaxis; prevent; professor; programs; public health relevance; social; standard of care; statistics; synergism; trend

 DESCRIPTION (provided by applicant): Having completed a BS in Biomedical Engineering and a MS, PhD, and post-doctoral fellowship in Epidemiology, Dr. Kristin Wall possesses a strong, quantitatively focused foundation in epidemiological methods, mathematical modeling, and research evaluating the effectiveness of interventions to treat and prevent HIV. Dr. Wall is currently a Research Assistant Professor at Emory University and co-Investigator on multiple grants to implement and evaluate couples-focused HIV testing and family planning interventions in Zambia and Rwanda. She is also Principal Investigator on a formative evaluation of pre-exposure prophylaxis acceptability among HIV discordant couples in the United States and the Principal Investigator on a grant to implement technologies that link patient records across HIV prevention and treatment services in Zambia. This K01 application outlines a four-year training and research plan structured to systematically expand upon Dr. Wall's training and research background to develop a unique, independently funded research agenda focused on HIV intervention resource allocation. Training plan: Dr. Wall proposes to gain competency in: 1) using infectious disease models for resource allocation, 2) building resource allocation optimization programs, and 3) understanding resource allocation decisions in health policy and practice. Competency in these areas will be achieved through didactic instruction and multidisciplinary mentorship from Dr. Phaedra Corso, an NIH-funded researcher and University of Georgia Foundation Professor of Human Health with decades of experience in health economic evaluation and translation of findings into health policy; Dr. Ron Brookmeyer, an NIH-funded researcher and UCLA Professor of Biostatics with extensive experience in HIV epidemic modeling and statistics; Dr. David Holtgrave, an NIH-funded Professor at Johns Hopkins and world-renowned expert in cost-effectiveness research, resource allocation, and health policy for HIV prevention programs; Dr. Arielle Lasry, Senior Health Economist at CDC Atlanta whose research focuses on HIV epidemic modeling and optimization programming for HIV prevention and treatment resource allocation in the United States and Africa; Dr. Gordon Streeb, Professor in the Emory Department of Economics and former United States Ambassador to Zambia whose work focuses on health economics, policy, development issues in Africa; and Dr. Susan Allen, Professor and founder of the Emory-based Rwanda Zambia HIV Research Group with more than 25 years of experience working in HIV prevention and treatment in sub-Saharan Africa and a successful history of translating research findings into national policy in Zambia and Rwanda. Dr. Wall will seek mentorship within and outside of Emory, where she has already built a strong network of research collaborators. As Emory does not currently house faculty focused on resource allocation optimization for HIV programs, her unique research agenda will be highly complementary to the existing HIV-related research portfolio at Emory. Research plan: Dr. Wall proposes to develop methods to optimize the allocation of limited HIV prevention and treatment resources to improve a defined health outcome. She will apply these methods to answer a relevant, timely, high-impact research question: what is an optimal and realistic allocation of combination HIV prevention and treatment resources in Zambia to minimize the number of new infections over a given time period? Two important resource allocation considerations are the leveraged costs and effects of interventions in combination and the realistic facilitators and barriers to making funding decisions. Though important, these two considerations are rarely systematically incorporated into resource allocation analyses. Dr. Wall proposes to advance methods that are inclusive of intervention synergy and real-world barriers facing resource allocation decision-makers. Models of the Zambian HIV epidemic that output the number of new HIV infections over time given a specific resource allocation scenario will be constructed. This model will be embedded in an optimization algorithm to minimize the number of new HIV infections for the current Zambian budget. Dr. Wall will then conduct formative qualitative work to determine the political, social, cultural, and ethical factors that influence HIV program resource allocation decision-making in Zambia by conducting semi-structured interviews with Ministry of Health members and other key stakeholders. Dr. Wall hypothesizes that: 1) the optimization model will be sensitive to assumptions of intervention cost-effectiveness ratios; 2) the number of HIV infections averted under the actual allocation scenario will be significantly lower than that for the optimal scenario; and 3) factors influencing stakeholder decision-making will include international guidelines, historical allocations, and sociocultural attitudes toward individual interventions. The proposed research aligns with the NIH Office of AIDS Research, NIMH Strategic Research Priorities, and NIMH DAR areas of high priority. The project will be the first to incorporate measures of intervention synergy and study both the rational and realistic allocation of HIV program resources in Zambia. Results will be used as preliminary data for an NIH NIMH R01 (highly responsive to PA-14-131) to develop the allocation model in light of changing guidelines and formative results. These investigations could inform decision-making in Zambia that improves HIV prevention and treatment outcomes. More broadly, the results of this work will have important implications for developing evidence-based resource allocation methodologies.

 描述（由适用提供）：克里斯汀·沃尔（Kristin Wall）博士在流行病学领域完成了生物医学工程和MS，博士学位和博士后奖学金的BS，在流行病学方法，数学模型，数学模型和研究评估治疗和预防HIV的有效性方面，具有强大的，定量为重点的基础。 Wall博士目前是埃默里大学（Emory University）的研究助理教授，并在赞比亚和卢旺达（卢旺达）进行了多项赠款的共同投资者，以实施和评估以夫妻为中心的艾滋病毒测试和计划生育干预措施。她还是美国对艾滋病毒不一致的夫妇的可接受性可接受性的形成性评估的首席研究者，以及对实施授予的技术的主要研究者，该技术可以实施跨赞比亚的艾滋病毒预防和治疗服务的患者记录。该K01应用程序概述了一项为期四年的培训和研究计划，该计划旨在系统地扩展沃尔博士的培训和研究背景，以开发独特的独立研究议程，专注于HIV干预资源分配。培训计划：沃尔博士提出的能力：1）使用传染病模型进行资源分配，2）建立资源分配优化计划； 3）了解卫生政策和实践中的资源分配决策。这些领域的能力将通过教学教学和多学科指导来实现Phaedra Corso博士。 NIH资助的研究人员兼UCLA生物统计学教授Ron Brookmeyer博士在HIV流行建模和统计学方面具有丰富的经验；约翰·霍普金斯（Johns Hopkins）的NIH资助教授兼成本效益研究，资源分配和艾滋病毒预防计划健康政策方面的世界知名专家David Holtgrave博士； CDC亚特兰大的高级健康经济学家Arielle Lasry博士的研究重点是美国和非洲的HIV预防和治疗资源分配的HIV流行性建模和优化计划； CDC亚特兰大的高级健康经济学家Arielle Lasry博士的研究重点是美国和非洲的HIV预防和治疗资源分配的HIV流行性建模和优化计划； Emory经济学系教授，前美国驻赞比亚大使Gordon Streetb博士的工作着重于非洲的健康经济学，政策，发展问题；总部位于埃默里（Emory）的卢旺达赞比亚艾滋病毒研究小组的教授兼创始人苏珊·艾伦（Susan Allen）博士拥有超过25年的撒哈拉以南非洲艾滋病毒预防和治疗经验，并成功地将研究结果转化为赞比亚和赞比亚和国家政策的历史 卢旺达。沃尔博士将在埃默里（Emory）内外寻求心态，她已经建立了强大的研究合作者网络。由于Emory目前不关注HIV计划的资源分配优化，因此她的独特研究议程将与Emory现有的与HIV相关的研究组合相互补充。研究计划：沃尔博士提出的旨在开发方法以优化有限的HIV预防和治疗资源的方法，以改善确定的健康结果。她将采用这些方法来回答相关，及时，高影响力的研究问题：什么是对赞比亚组合艾滋病毒预防和治疗资源的最佳和现实分配，以最大程度地减少给定时间段的新感染数量？两个重要的资源分配考虑因素是干预措施的杠杆成本和效果，以及现实的促进者和做出资金决定的障碍。尽管很重要，但这两个考虑很少会系统地纳入资源分配分析中。沃尔博士的提议提出了推进涉及资源分配决策者的干预协同和现实障碍的方法的方法。在特定资源分配方案的情况下，会随着时间的推移输出新的HIV感染数量的赞比亚HIV流行模型。该模型将嵌入到优化算法中，以最大程度地减少当前赞比亚预算的新艾滋病毒感染的数量。然后，沃尔博士将通过与卫生部成员和其他主要利益相关者进行半结构化访谈，从而确定影响赞比亚艾滋病毒计划资源分配决策的政治，社会，文化和道德因素。沃尔博士假设：1）优化模型将对干预成本效益比的假设敏感； 2）在实际分配情况下避免的艾滋病毒感染数量将显着低于最佳情况下的艾滋病毒感染数量； 3）因素影响利益相关者的决策将包括国际准则，历史分配以及针对个人间隔的社会文化出勤。拟议的研究与NIH AIDS研究办公室，NIMH战略研究的重点和高优先级的NIMH DAR领域保持一致。该项目将是第一个纳入干预协同措施并研究合理和现实的项目的项目 赞比亚的艾滋病毒计划资源分配。结果将用作NIH NIMH R01（对PA-14-131的高度响应）的初步数据，以根据改变准则和形成性结果来开发分配模型。这些调查可以为赞比亚的决策提供依据，以改善艾滋病毒的预防和治疗结果。更广泛地说，这项工作的结果将对开发基于证据的资源分配方法具有重要意义。