PEARL 2.0: The impact of the Ending the HIV Epidemic initiative and risk factor interventions on the projected multimorbidity burden and healthcare costs for people aging with HIV in the United States

PEARL 2.0：“结束艾滋病毒流行”倡议和风险因素干预措施对美国艾滋病毒感染者的预计多重病负担和医疗保健费用的影响

• 批准号: 10886848
• 负责人: Keri Nicole Althoff
• 金额: $ 71.82万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10886848
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; African American; Age; Age Distribution; Aging; American; Black race; Budgets; Cardiovascular Diseases; Caring; Cessation of life; Clinical; Collaborations; Computer Simulation; Data; Decision Making; Disparity; Economic Models; Effectiveness of Interventions; Elderly; Epidemic; Epidemiology; Ethnic Origin; Funding; Future; Geriatrics; Goals; Guidelines; HIV; HIV diagnosis; HIV/AIDS; Health; Health Care Costs; Health Services; Health system; Healthcare; Healthcare Systems; Heterogeneity; Heterosexuals; Hispanic; Hispanic Populations; Intervention; Kidney Diseases; Life Expectancy; Link; Malignant Neoplasms; Modeling; Obesity; Outcome; Overweight; Persons; Policies; Polypharmacy; Prevention; Privatization; Race; Research; Research Priority; Resource Allocation; Resources; Risk; Risk Factors; Risk Reduction; Shapes; Smoking; Subgroup; Testing; United States; United States National Institutes of Health; Update; Weight Gain; Woman; antiretroviral therapy; care costs; clinical care; cohort; comorbidity; cost; cost effective; cost effectiveness; cost estimate; cost-effectiveness evaluation; cost-effectiveness ratio; design; diabetes risk; end stage liver disease; experience; federal policy; health disparity; health inequalities; human old age (65+); improved; incremental cost-effectiveness; injection drug use; men; men who have sex with men; middle age; models and simulation; multidisciplinary; multiple chronic conditions; obesity treatment; programs; sex; simulation; smoking cessation; surveillance data

PROJECT SUMMARY Within the next decade, nearly 1 million people aging with HIV (PAH) using antiretroviral therapy (ART) in the United States (US) will experience multi-decade life expectancy. The goal of this project is to build a suite of modules to further the ProjEcting Age, multimoRbidity and poLypharmacy (PEARL) computer simulation model’s capacity to inform clinical program and policy decision-making and resource allocation in governmental and private healthcare systems in efforts meet the future needs of caring for PAH. The Ending the HIV Epidemic (EHE) efforts will undoubtedly re-shape the age distributions of Black/African American (AA), Hispanic, and white PAH within sex-and-HIV acquisition risk groups. Projections under various scenarios of EHE goal attainment strategies within these subgroups are needed to answer the question: “How will EHE efforts impact the number of older PAH (who need clinical care) over the next two decades?” As PAH experience a greater burden of multimorbidity than people without HIV, and disparities persist within PAH subgroups, clinical program and policy decision-makers need to know: “Can reductions in prominent risk factors reduce future multimorbidity in PAH in the US?” Simulating reductions in prominent risk factors, such as smoking and obesity, and estimating the impact on future multimorbidity will provide data where none exist. Finally, by investigating the question “What are the future healthcare costs for caring for PAH in the US over the next 2 decades?” clinical directors, health systems and state and federal policy decision-makers can prepare for future health care needs and allocation of resources. The established PEARL modeling team will (a) collaborate closely with Johns Hopkins HIV Epidemic Economic Model (JHEEM) team to construct a module to simulate the impact of EHE efforts, (b) continue their beneficial partnership with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to construct a comorbidities prevention module, and (c) construct a costing module to achieve the following among 15 PAH subgroups using ART in the US through 2040: AIM 1: To assess the impact of EHE goals on the projected number and age distribution. AIM 2: To project the impact of reducing prominent risk factors on future multimorbidity burden. AIM 3: To estimate the cost effectiveness of interventions to reduce risk factors and project HIV- and non-HIV- related healthcare costs. The proposed aims align with the research priorities of the 2021-25 Trans-NIH Plan for HIV and HIV-Related Research and include Multidisciplinary Studies of HIV/AIDS and Aging (PAR-21-068) priority outcomes. Findings will provide key HIV epidemiologic and health services data within 15 PAH subgroups to guide clinical programs and informing healthcare resource allocations to ultimately improve the health of PAH in the US.

项目摘要 在接下来的十年中，使用抗逆转录病毒疗法（ART）在接下来的十年中 美国（美国）将体验多年的预期寿命。该项目的目的是建造一套 模块以进一步预测年龄，多种病态和多功能（Pearl）计算机模型的模型 在政府和 私人医疗保健系统努力满足照顾PAH的未来需求。 艾滋病毒流行（EHE）的结局无疑会重新塑造黑人/非洲的年龄分布 美国（AA），西班牙裔和白色PAH在性别和hiv获取风险群体中。在各种下的预测 需要在这些子组中实现目标实现策略的方案来回答以下问题：“如何 EHE的努力会影响未来二十年的旧PAH（需要临床护理）的数量吗？” 与没有艾滋病毒的人相比，多发病的燃烧更大，并且在PAH中持续存在差异 亚组，临床计划和政策决策者需要知道：“可以减少突出的风险因素 减少美国PAH的未来多种多发病？ 和肥胖，并估算对未来多种多发性影响的影响，将提供不存在的数据。最后，by 调查一个问题：“在接下来的2中照顾PAH的未来医疗保健费用是多少 几十年？”临床主管，卫生系统以及州和联邦政策决策者可以为未来做准备 医疗保健需求和资源分配。 既定的珍珠建模团队将（a）与约翰·霍普金斯艾滋病毒流行经济紧密合作 模型（JHEEM）团队构建一个模块以模拟EHE努力的影响，（b）继续他们的好处 与北美艾滋病研究与设计（NA-Accord）合作的合作 构建预防合并症模块，（c）构建一个成本核算模块，以实现以下几点 15个PAH亚组在美国直到2040年使用艺术： 目标1：评估目标目标对预计数量和年龄分布的影响。 目的2：投影减少突出风险因素对未来多发性多发性伯恩的影响。 目标3：估算干预措施的成本效益以减少危险因素和投射HIV和非HIV- 相关的医疗保健费用。 拟议的目的与2021 - 25年艾滋病毒和HIV相关的2021-25 Trans-NIH计划的研究重点保持一致 研究并包括艾滋病毒/艾滋病和衰老的多学科研究（PAR-21-068）优先级。发现 将在15个PAH亚组中提供关键的HIV流行病学和健康服务数据，以指导临床计划 并告知医疗资源分配，以最终改善美国PAH的健康状况。