Cardiovascular Disease in South African HIV Patients: Value of Prevention

南非艾滋病毒患者的心血管疾病：预防的价值

基本信息

批准号：
9064426
负责人：
Emily Parker Hyle
金额：
$ 17.93万
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：
2016-01-15 至 2020-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9064426
关键词：
AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Africa South of the Sahara African Aging-Related Process Algorithms Cardiovascular Diseases Caring Clinical Clinical Trials Collaborations Comorbidity Cost Effectiveness Analysis Coupled Data Decision Making Development Diabetes Mellitus Diagnosis Disease Disease model Epidemic Epidemiology Europe European Event Foundations Funding General Population HIV Healthcare Hypertension Incidence Individual International Intervention Investigation Life Longevity Mentors Mentorship Metabolic Methodology Methods Modeling Modification Morbidity - disease rate Myocardial Infarction Outcome Patients Policies Population Prevention Public Health Research Research Personnel Research Priority Risk Risk Factors Risk Reduction Scientist Source South Africa South African Stroke Time Training Uncertainty United States National Institutes of Health World Health Organization antiretroviral therapy cardiovascular disorder risk career clinical care clinical epidemiology cohort combat cost cost effective cost effectiveness experience improved low and middle-income countries mathematical model models and simulation mortality multidisciplinary novel prevent programs public health intervention public health relevance screening skills treatment effect

项目摘要

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD), including stroke and myocardial infarction (MI), is an emerging public health concern in South Africa. Because of a rising incidence of CVD risk factors such as hypertension and diabetes, South Africa, and all of sub-Saharan Africa, are likely to experience a dramatic increase in CVD in the coming decades. HIV-infected patients are at a particularly increased risk for stroke and MI, as demonstrated in multiple US and European cohorts, especially in the setting of successful treatment with antiretroviral therapy (ART). When coupled with the already increasing incidence of CVD among the general population in South Africa, HIV- infected patients in South Africa are likely to be at major risk for CVD. Further research is essential to assess the scope of this emerging problem, as well as strategies to reduce associated morbidity and mortality. The NIH Office of AIDS Research for FY 2015, as well as the WHO Priority Agenda for global research priorities in CVD, have called for further investigation of these public health concerns. By using simulation modeling to investigate both CVD and HIV in South Africa, this proposed research will examine the long-term impact of CVD among people living with HIV/AIDS with the following aims: 1) To develop a novel state-transition model of CVD risk and outcomes in South Africa and to project the clinical impact of CVD in the general population. 2) To assess the competing risks of CVD and HIV in South Africa using the novel CVD model with an established HIV simulation model. 3) To compare the clinical impact, costs, and cost-effectiveness of screening, treatment, and integration of care for hypertension in HIV-infected patients. The simulation modeling approach will also assess the potential for public health interventions to improve clinical outcomes and to provide cost-effective strategies to reduce CVD risks. The research proposed in this K01 proposal will build on my previous training in clinical epidemiology and mathematical modeling, with additional focused mentorship by Drs. Kenneth Freedberg and Milton Weinstein, to develop simulation models of CVD risks, outcomes, and interventions that will allow for cost-effectiveness analyses. The proposed training plan and research experience will provide the foundation for a career as an independent investigator focused on the dual epidemic of CVD and HIV in sub-Saharan Africa.

描述（由申请人提供）：心血管疾病（CVD），包括中风和心肌梗塞（MI），是南非一个新兴的公共卫生问题，因为高血压和糖尿病等 CVD 危险因素的发病率不断上升。以及整个撒哈拉以南非洲地区，在未来几十年中，艾滋病毒感染者的心血管疾病发病率可能会急剧增加，尤其是美国和欧洲的多个队列研究表明，他们患中风和心肌梗塞的风险尤其增加。在抗逆转录病毒疗法 (ART) 成功治疗的情况下，加上南非普通人群中 CVD 发病率的增加，南非的 HIV 感染患者可能面临 CVD 的主要风险。 NIH 2015 财年艾滋病研究办公室以及 WHO 全球心血管病研究优先事项的优先议程都呼吁进一步制定评估这一新出现问题的范围以及降低相关发病率和死亡率的战略。通过使用模拟模型来调查南非的 CVD 和 HIV，这项拟议的研究将研究 CVD 对 HIV/艾滋病患者的长期影响，其目标如下： 1) 制定一个南非 CVD 风险和结果的新型状态转换模型，并预测 CVD 对普通人群的临床影响 2) 使用新型 CVD 模型和已建立的 HIV 模拟来评估南非 CVD 和 HIV 的竞争风险。 3）临床比较。模拟建模方法还将评估公共卫生干预措施改善临床结果的潜力，并提供具有成本效益的策略。本 K01 提案中提出的研究将建立在我之前的临床流行病学和数学建模培训的基础上，并得到 Kenneth Freedberg 和 Milton Weinstein 博士的额外指导，以开发 CVD 风险、结果和干预措施的模拟模型。拟议的培训计划和研究经验将为专注于撒哈拉以南非洲地区心血管疾病和艾滋病毒双重流行的独立调查员的职业生涯奠定基础。