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.

项目概要 未来十年内，近 100 万艾滋病毒 (PAH) 老年患者正在接受抗逆转录病毒治疗 (ART) 美国（US）的预期寿命将达到数十年。该项目的目标是建造一套。 进一步推进 ProjEcting Age、multimorbidity 和 polypharmacy (PEARL) 计算机模拟模型的模块 为政府和政府部门的临床计划和政策决策以及资源分配提供信息的能力 私营医疗保健系统正在努力满足未来照顾 PAH 的需求。 终结艾滋病毒流行（EHE）的努力无疑将重塑黑人/非洲人的年龄分布 不同性别和艾滋病毒感染风险组中的美国人 (AA)、西班牙裔和白人 PAH。 需要在这些亚组内制定 EHE 目标实现策略的情景来回答以下问题：“如何 EHE 工作是否会影响未来二十年老年 PAH（需要临床护理）的数量？” 与未感染艾滋病毒的人相比，他们承受着更大的多重疾病负担，而且肺动脉高压患者中仍然存在差异 亚组、临床计划和政策决策者需要知道：“可以减少显着的风险因素吗？ 减少美国未来多发性肺动脉高压的多重发病率？” 和肥胖，并估计对未来多种疾病的影响将提供不存在的数据。 调查“未来 2 年内美国治疗 PAH 的未来医疗费用是多少”这一问题 临床主任、卫生系统以及州和联邦政策决策者可以为未来做好准备吗？ 卫生保健需求和资源分配。 成立的 PEARL 建模团队将 (a) 与约翰·霍普金斯大学艾滋病毒流行经济研究所密切合作 模型（JHEEM）团队构建了一个模块来模拟 EHE 努力的影响，（b）继续其有益的 与北美艾滋病队列研究与设计合作组织 (NA-ACCORD) 合作， 构建一个并发症预防模块，以及 (c) 构建一个成本计算模块以实现以下目标： 到 2040 年，美国将有 15 个使用 ART 的 PAH 亚组： 目标 1：评估 EHE 目标对预计人数和年龄分布的影响。 目标 2：预测减少突出风险因素对未来多重疾病负担的影响。 目标 3：评估减少风险因素并预测艾滋病毒和非艾滋病毒干预措施的成本效益 相关的医疗费用。 拟议的目标与 2021-25 年跨 NIH 艾滋病毒和艾滋病毒相关计划的研究重点一致 研究并包括艾滋病毒/艾滋病和老龄化的多学科研究 (PAR-21-068) 的优先结果。 将提供 15 个 PAH 亚组内的关键 HIV 流行病学和卫生服务数据，以指导临床计划 并告知医疗资源分配，以最终改善美国多环芳烃的健康。