Clinical and Economic Outcomes of HIV, Cigarette Smoking, and Smoking Cessation Interventions

艾滋病毒、吸烟和戒烟干预措施的临床和经济成果

基本信息

批准号：
9981711
负责人：
Krishna P Reddy
金额：
$ 18.62万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2022-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9981711
关键词：
Abstinence Acquired Immunodeficiency Syndrome Adult Age Anti-Retroviral Agents Area Attention Award Behavioral Behavioral Sciences Biometry Caring Chronic Obstructive Airway Disease Clinical Clinical Research Complex Computer Simulation Cost Effectiveness Analysis Counseling Data Disease Economics Effectiveness of Interventions Environment Epidemic Epidemiology General Hospitals General Population Goals Guidelines HIV HIV Seronegativity HIV/TB Health Care Costs Health Policy Health behavior Incidence Individual International Intervention Life Expectancy Lung diseases Malignant neoplasm of lung Massachusetts Mentored Research Scientist Development Award Mentors Mentorship Methodology Modeling Morbidity - disease rate Myocardial Infarction NIH Office of AIDS Research National Institute of Drug Abuse Natural History Outcome Outcomes Research Patient Care Patients Persons Pharmaceutical Preparations Pharmacotherapy Policies Population Positioning Attribute Prevalence Prevention Provider Public Health Public Health Schools Publishing Regimen Research Research Personnel Research Training Resources Smoking Smoking Behavior Smoking Cessation Intervention Symptoms Time Tobacco Tobacco Use Cessation Tobacco use Training Tuberculosis antiretroviral therapy authority base behavioral outcome burden of illness care providers cigarette smoking clinical decision-making clinical effect collaborative environment comorbidity cost cost effectiveness cost-effectiveness evaluation design economic impact economic outcome epidemiology study experience health economics improved innovation mathematical model medical schools models and simulation mortality mortality risk multidisciplinary novel prevent programs simulation skills smoking cessation smoking prevalence tobacco cessation intervention

项目摘要

Project Summary The prevalence of cigarette smoking among people living with HIV (PLWH) in the US is about double that among the general population. Tobacco and HIV may act synergistically to increase morbidity and mortality risks. Among PLWH on antiretroviral therapy (ART), smoking now reduces life expectancy more than HIV itself. The footprint of smoking will likely grow as PLWH age. Compared to the general population, PLWH have been less likely to quit smoking. Smoking cessation interventions have not been widely implemented in HIV care, partly due to the lack of guidance for patients and care providers on the optimum cessation strategies in this population. While improvements in HIV care have largely been focused on novel antiretroviral drug regimens, there is still much to be accomplished in reducing the burden of smoking-attributable disease. In an environment of growing attention to resource utilization, where annual ART costs exceed $30,000 per patient, evaluating the cost-effectiveness of smoking cessation interventions in promoting abstinence and reducing the toll of smoking is critically important. I am a pulmonologist with a background in economics and prior experience in HIV and tuberculosis research. I am motivated to investigate efficient ways to reduce the burden of disease caused by smoking and HIV. Simulation modeling can project long-term clinical and economic outcomes of behaviors, diseases, and interventions. My long-term goal is to become a world expert on the application of evidence- and model-based approaches to clinical decision-making and public health policy at the intersection of tobacco, HIV, and lung disease. In my recent research training, I have learned the fundamentals of disease simulation via a validated and widely-published computer simulation of HIV natural history and outcomes, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-US model. To achieve independence, I require further training in: 1) modeling complex health behaviors; 2) deriving clinical and economic outcome data; and 3) designing and conducting cost-effectiveness analysis. To enhance my methodologic skills in these areas, I have outlined a plan of didactic coursework and assembled a multidisciplinary mentorship team. My primary mentor is Dr. Rochelle Walensky, an expert in HIV outcomes research and modeling, and my co-mentor is Dr. Nancy Rigotti, an international authority in tobacco cessation interventions and control policy. My mentorship team additionally includes experts in behavioral science (Park), comorbidities in PLWH (Triant), lung disease epidemiology (Christiani), chronic obstructive pulmonary disease in PLWH (Medoff), applied epidemiology and biostatistics (Parker), resource utilization and health economics (Resch), mathematical modeling and cost-effectiveness analysis (Weinstein and Paltiel), and HIV outcomes and policy (Freedberg). With their guidance, I will leverage the CEPAC-US model to achieve the following specific research aims: 1) to expand a pilot US tobacco/HIV simulation model to account for changes in an individual's smoking behaviors over time; 2) to determine the clinical and economic impacts – including those related to myocardial infarction, chronic obstructive pulmonary disease, and lung cancer – of smoking among PLWH; and 3) to examine the cost-effectiveness of interventions, including behavioral counseling and pharmacotherapy, to reduce smoking-associated morbidity and mortality among PLWH. This research responds directly to the 2016 priority areas of the NIH Office of AIDS Research, which considers HIV-associated comorbidities to be a high priority topic. The research plan is innovative by integrating HIV with smoking behaviors, outcomes, and costs. Cost-effectiveness analysis can help clinicians and policymakers prioritize among interventions for PLWH. Massachusetts General Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health provide an exceptional intellectual and collaborative environment for this research. Building on my prior research experience and training, the existing CEPAC-US model, and methodologic training via coursework and expert mentorship, I am well-positioned to accomplish the proposed aims and ultimately apply for an R01 award focused on tobacco use and HIV disease.

项目概要美国艾滋病毒感染者 (PLWH) 吸烟率约为美国的两倍烟草和艾滋病毒可能协同作用，增加发病率和死亡率。在接受抗逆转录病毒治疗（ART）的感染者中，吸烟比艾滋病毒更能降低预期寿命。随着感染者年龄的增长，吸烟的足迹可能会增加。与一般人群相比，艾滋病病毒感染者戒烟的可能性较小。干预措施尚未在艾滋病毒护理中广泛实施，部分原因是缺乏对患者和患者的指导护理提供者了解该人群的最佳戒烟策略，同时艾滋病毒护理有所改善。主要集中在新型抗逆转录病毒药物治疗方案上，但在减少在日益关注资源利用的环境中，吸烟引起的疾病的负担。每位患者每年 ART 费用超过 30,000 美元，评估戒烟的成本效益促进戒烟和减少吸烟造成的死亡人数的干预措施至关重要。我是一名肺科医生，拥有经济学背景，并拥有艾滋病毒和结核病研究经验。我有动力研究有效的方法来减轻吸烟和艾滋病毒造成的疾病负担。仿真模型可以预测行为、疾病和疾病的长期临床和经济结果我的长期目标是成为应用基于证据和模型的世界专家。烟草、艾滋病毒和肺部交叉领域的临床决策和公共卫生政策方法在我最近的研究培训中，我通过经过验证的方法学习了疾病模拟的基础知识。以及广泛发表的艾滋病毒自然史和结果的计算机模拟，预防艾滋病并发症（CEPAC）-美国模式。为了实现独立，我需要进一步的培训：1）复杂的健康行为建模；2）推导；临床和经济结果数据；3) 设计和进行成本效益分析。根据我在这些领域的方法论技能，我概述了教学课程计划并组装了我的主要导师是艾滋病毒结果专家 Rochelle Walensky 博士。研究和建模，我的共同导师是国际戒烟权威 Nancy Rigotti 博士我的指导团队还包括行为科学专家（Park）， PLWH 的合并症 (Triant)、肺部疾病流行病学 (Christiani)、慢性阻塞性肺病艾滋病毒感染者（PLWH）（Medoff）、应用流行病学和生物统计学（Parker）、资源利用和卫生经济学 (Resch)、数学模型和成本效益分析（Weinstein 和 Paltiel）以及艾滋病毒结果在他们的指导下，我将利用 CEPAC-US 模式来实现以下目标。具体研究目标： 1) 扩大美国烟草/艾滋病毒模拟试点模型，以解释烟草/艾滋病毒的变化个人随时间的吸烟行为；2) 确定临床和经济影响——包括那些影响吸烟与心肌梗塞、慢性阻塞性肺病和肺癌有关 PLWH；3) 检查干预措施的成本效益，包括行为咨询和药物治疗，以降低 PLWH 中与吸烟相关的发病率和死亡率。这项研究直接响应了 NIH 艾滋病研究办公室 2016 年的优先领域，该办公室认为艾滋病毒相关合并症将成为一个高度优先的主题该研究计划通过将艾滋病毒与艾滋病毒结合起来进行创新。吸烟行为、结果和成本分析可以帮助封建和政策制定者。麻省总医院、哈佛医学院和 PLWH 的干预措施优先考虑。哈佛大学陈曾熙公共卫生学院提供卓越的智力和协作环境基于我之前的研究经验和培训、现有的 CEPAC-US 模型以及通过课程作业和专家指导进行方法培训，我有能力完成拟议的目标目标并最终申请专注于烟草使用和艾滋病毒疾病的 R01 奖项。