Computational discovery of effective hepatitis C intervention strategies

有效丙型肝炎干预策略的计算发现

• 批准号: 9383459
• 负责人: Basmattee Boodram
• 金额: $ 42.33万
• 依托单位: LOYOLA UNIVERSITY CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9383459
• 关键词: Address; Adherence; Antiviral Agents; Behavioral; Caring; Characteristics; Chicago; Chronic; Clinical Trials; Communities; Complex; Computer Simulation; Cost Effectiveness Analysis; Counseling; Data; Data Set; Development; Development Plans; Diagnosis; Direct Costs; Disease Progression; Drug usage; Event; Exposure to; Funding; General Population; Geographic Factor; Geographic Locations; Geography; Goals; Grouping; Harm Reduction; Health; Health Services; Hepatitis C; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Transmission; Illinois; Immune System Diseases; Incidence; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Intervention; Kinetics; Lead; Life Style; Liver diseases; Meta-Analysis; Methodology; Methods; Modeling; Needle-Exchange Programs; Network-based; Opioid Rotation; Oral; Phase; Policy Developments; Policy Maker; Population; Prevalence; Prevention; Prisons; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Science; Social Interaction; Strategic Planning; System; Time; United States Dept. of Health and Human Services; Viral; Viral hepatitis; Work; World Health; World Health Organization; base; chronic liver disease; design; effective intervention; epidemiologic data; epidemiological model; improved; large scale simulation; methicillin resistant Staphylococcus aureus; models and simulation; mortality; pathogen; prevent; prognostic; programs; scale up; social; transmission process; vaccine trial

7. PROJECT SUMMARY/ABSTRACT Hepatitis C (HCV) is a leading cause of chronic liver disease and mortality worldwide. The World Health Organization (WHO) has recently recognized the need to prevent and control HCV infection, and proposed that HCV elimination is feasible by 2030 by reducing new chronic infections by 90% and HCV-related mortality by 65%. In the U.S., elimination strategies are urgently needed that focus on persons who inject drugs (PWID), the group at most risk for acquiring and transmitting HCV infection. Despite the long-term availability of harm reduction strategies such as syringe exchange programs (SEP), opioid substitution therapies (OSTs), and behavioral counseling, HCV incidence in the U.S. is on the rise among PWID. The recent availability of all oral direct-acting antivirals (DAAs) with high reported cure rates (e.g., >90%) that can prevent liver disease progression and HCV transmission, combined with prevention and harm reduction strategies, make HCV elimination an attainable goal. However, given considerable barriers (e.g., cost of DAAs, poor linkage to care and adherence, possible reinfection, PWID lifestyle), it is essential for policy development and strategic planning to understand the factors that would most effectively promote HCV elimination among PWID. Understanding the dynamic and complex interplay of factors at the individual (e.g., risk behaviors), social (e.g., injection networks), structural (e.g., access to syringe exchange programs and opioid substitution therapies), and geographic (e.g., non-urban residence) levels is essential to improve understanding and development of HCV elimination strategies. Current models cannot account for such dynamic and complex interactions. As such we propose to develop a comprehensive, data-driven agent-based model for Hepatitis C Elimination in PWID (HepCEP) using the Chicago PWID population as a template and proof of concept that would enable policy makers to identify the most effective intervention strategies for elimination of HCV by 2030 based on the aforementioned WHO's proposed reduction estimates. The long term significance of these efforts would be to adapt the HepCEP framework to (i) model HCV transmission in the general population of Chicago and in Illinois prisons, (ii) forecast the spread of HCV in other U.S. urban and non-urban PWID populations (e.g., Albuquerque, NM), (iii) perform cost-effectiveness analyses, and (iv) assist vaccine-trial sponsors in designing and evaluating clinical trials.

7. 项目概要/摘要 丙型肝炎 (HCV) 是全世界慢性肝病和死亡的主要原因。世界卫生 世界卫生组织（WHO）最近认识到预防和控制HCV感染的必要性，并提出： 到 2030 年，通过将新发慢性感染减少 90%，将 HCV 相关死亡率减少 90%，消除 HCV 是可行的 65%。在美国，迫切需要针对注射吸毒者（PWID）、 感染和传播 HCV 风险最高的群体。尽管长期存在危害 减少策略，例如注射器交换计划（SEP）、阿片类药物替代疗法（OST）和 行为咨询方面，美国吸毒者中丙型肝炎病毒的发病率呈上升趋势。最近提供所有口头 具有高报告治愈率（例如 >90%）的直接作用抗病毒药物 (DAA)，可预防肝病 进展和丙型肝炎病毒传播，结合预防和减少危害策略，使丙型肝炎病毒 消除是一个可以实现的目标。然而，考虑到相当大的障碍（例如 DAA 的成本、与护理的联系不畅） 和依从性、可能的再感染、吸毒者的生活方式），这对于政策制定和战略规划至关重要 了解最有效促进注射吸毒者消除 HCV 的因素。了解 个体因素（例如风险行为）、社会因素（例如注射网络）的动态和复杂的相互作用， 结构性（例如，获得注射器交换计划和阿片类药物替代疗法）和地理性（例如， 非城市居民）水平对于提高丙肝消除的认识和发展至关重要 策略。当前的模型无法解释这种动态和复杂的相互作用。因此我们建议 使用以下方法开发一个全面的、基于数据驱动的基于代理的丙型肝炎消除注射吸毒者模型 (HepCEP) 芝加哥注射吸毒者人口作为模板和概念证明，使政策制定者能够识别 根据上述世界卫生组织的建议，到 2030 年消除丙肝病毒最有效的干预策略 拟议的削减估计数。这些努力的长期意义在于调整 HepCEP (i) 芝加哥普通人群和伊利诺伊州监狱中 HCV 传播模型的框架，(ii) 预测 HCV 在美国其他城市和非城市吸毒者人群（例如新墨西哥州阿尔伯克基）中的传播，(iii) 成本效益分析，(iv) 协助疫苗试验申办者设计和评估临床试验。