Estimating the cost-effectiveness of HIV pre-exposure prophylaxis delivery through maternal and child health clinics in Kenya

评估肯尼亚妇幼保健诊所提供艾滋病毒暴露前预防的成本效益

• 批准号: 9926435
• 负责人: David Allen Roberts
• 金额: $ 4.07万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926435
• 关键词: AIDS prevention; Adherence; Affect; Africa South of the Sahara; Behavioral; Benchmarking; Breast Feeding; Budgets; Capital; Cessation of life; Characteristics; Clinic; Clinical; Communicable Diseases; Data; Demography; Economic Models; Epidemic; Female; Foundations; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health system; High Risk Woman; Human Resources; Incidence; Individual; Infant; Infection; Intervention; Kenya; Laboratories; Maternal and Child Health; Maternal-Child Health Services; Mentorship; Methods; Modeling; Morbidity - disease rate; National Health Programs; Natural History; Output; Perinatal; Pharmaceutical Preparations; Policies; Population; Postnatal Care; Postpartum Women; Pregnancy; Pregnant Women; Prevention strategy; Preventive Intervention; Provider; Public Health; Publishing; Research Personnel; Resources; Risk; Risk Factors; Screening procedure; Services; Sexually Transmitted Diseases; Solid; Study models; Supervision; Testing; Time; Time and Motion Studies; Training; Uncertainty; Woman; antenatal; antiretroviral therapy; base; career; clinical care; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; cost-effectiveness ratio; design; disability-adjusted life years; female sex worker; health economics; high risk; implementation strategy; incremental cost-effectiveness; mathematical model; medical supply; men who have sex with men; models and simulation; mortality; pre-exposure prophylaxis; prevent; program costs; programs; randomized trial; scale up; sexual relationship; success; targeted delivery; transmission process; trial comparing; uptake; young woman

ABSTRACT HIV disproportionately affects young women, and nearly 200,000 young women in sub-Saharan Africa are infected with HIV each year. Pre-exposure prophylaxis (PrEP) is an effective method for preventing HIV infection and offers promise as a female-controlled intervention. However, effective strategies for efficiently identifying women at high risk of HIV infection and engaging them in PrEP have not been established. Pregnant and postpartum women have elevated risk of HIV infection, and HIV infection acquired during pregnancy can be transmitted to infants perinatally or during breastfeeding. Therefore, integrating PrEP into existing maternal and child health (MCH) clinics could be an efficient strategy for preventing new HIV infections. National health programs operating under limited resources need guidance to determine where to roll out PrEP to maximize impact. The proposed project will use mathematical modeling combined with data from two implementation studies to evaluate the cost-effectiveness of PrEP delivery through MCH clinics in western Kenya. In Aim 1, we will conduct a microcosting study as part of a PrEP demonstration project to estimate the incremental cost of integrating PrEP into routine MCH services. In Aim 2, we will develop an individual-based mathematical model of HIV transmission calibrated to HIV dynamics in western Kenya that simulates HIV natural history, demography, sexual relationship formation, and explicitly models the flow of individuals through HIV and MCH services. Using this model, we will evaluate the population-level impact of PrEP uptake by pregnant and postpartum women attending MCH clinics. Combined with the cost estimates from Aim 1, we will calculate the cost-effectiveness and budget impact of this PrEP delivery strategy compared to standard thresholds and other HIV prevention interventions. A key benchmark of program success is the extent to which PrEP use is prioritized among individuals with high HIV risk. In Aim 3, we will estimate the cost-effectiveness of risk score-guided vs. universal PrEP delivery to pregnant women. This analysis will incorporate results from a randomized trial comparing PrEP uptake, retention, and adherence between the two strategies into the model developed in Aim 2. Together, the results from these Aims will help guide policymakers decide how to most effectively scale up PrEP delivery in sub-Saharan Africa. In addition to these Aims, the proposal describes a rigorous training plan in mathematical modeling, health economics, and clinical care as well as mentorship from leading HIV prevention researchers. Combined, this proposal will provide a solid foundation for a career as an infectious disease clinician and public health researcher contributing to efforts to control the HIV epidemic.

抽象的 艾滋病毒不成比例地影响年轻妇女，撒哈拉以南非洲的近200,000名年轻妇女是 每年感染艾滋病毒。暴露前预防（PREP）是预防HIV感染的有效方法 并提供承诺作为女性控制的干预措施。但是，有效识别的有效策略 尚未确定患有艾滋病毒感染并参与PREP的高风险的妇女。怀孕和 产后妇女患HIV感染的风险较高，怀孕期间获得的艾滋病毒感染可能是 围产期或母乳喂养期间传播给婴儿。因此，将准备纳入现有母亲和 儿童健康（MCH）诊所可能是预防新的HIV感染的有效策略。国家健康 在有限资源下运行的程序需要指导，以确定在何处进行准备以最大化 影响。拟议的项目将使用数学建模与两个实现的数据结合 研究通过肯尼亚西部的MCH诊所评估PREP递送的成本效益。在AIM 1中，我们 将进行一项微固定研究，作为准备演示项目的一部分，以估计 将PREP集成到常规MCH服务中。在AIM 2中，我们将开发一个基于个体的数学模型 在肯尼亚西部校准艾滋病毒动态的艾滋病毒传播模拟了艾滋病毒自然历史， 人口统计学，性关系形成，并明确模拟个人通过艾滋病毒和MCH的流程 服务。使用此模型，我们将评估怀孕和 产后妇女参加MCH诊所。结合AIM 1的成本估算，我们将计算 与标准阈值相比，此准备交付策略的成本效益和预算影响 艾滋病毒预防干预措施。计划成功的关键基准是优先使用准备的程度 在艾滋病毒高风险的人中。在AIM 3中，我们将估计风险评分引导的成本效益。 通用的准备向孕妇分娩。该分析将结合随机试验的结果 将两种策略之间的准备摄取，保留和依从性比较目标中开发的模型 2。总之，这些目标的结果将有助于指导决策者决定如何最有效地扩展 在撒哈拉以南非洲的预付款。除这些目标外，该提案还描述了严格的培训计划 在数学建模，卫生经济学和临床护理以及领先的HIV预防的指导中 研究人员。该提案结合在一起，将为作为传染病临床医生的职业提供坚实的基础 和公共卫生研究人员为控制艾滋病毒流行而做出贡献。