Localized economic modeling to optimize public health strategies for HIV treatment and prevention

本地化经济模型可优化艾滋病毒治疗和预防的公共卫生策略

• 批准号: 9119314
• 负责人: Bohdan Nosyk
• 金额: $ 47.72万
• 依托单位: SIMON FRASER UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9119314
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Agonist; Alcohol or Other Drugs use; Annual Reports; Area; Baltimore; Caring; Characteristics; Cities; Consultations; Data; Data Sources; Decision Making; Diagnosis; Disease; Drug usage; Economic Models; Effectiveness; Ensure; Epidemic; Epidemiology; Foundations; Frequencies; Funding; Future; Goals; HIV; HIV risk; Health; Health Benefit; Health Resources; Health Services Accessibility; Healthcare Systems; Human immunodeficiency virus test; Incidence; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Intervention Studies; Knowledge; Life; Location; Los Angeles; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Needle-Exchange Programs; New York City; North America; Observational Study; Opioid; Output; Pattern; Performance; Play; Population; Prevention; Production; Prophylactic treatment; Public Health; Publications; Publishing; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Role; Scientific Advances and Accomplishments; Secure; Services; Site; Specificity; Substance Use Disorder; Surveys; System; Target Populations; Testing; Time; Translational Research; United States National Institutes of Health; Update; Work; antiretroviral therapy; base; burden of illness; cost; cost effective; cost effectiveness; design; effective intervention; flexibility; health care delivery; improved; innovation; metropolitan; model development; mortality; national surveillance; novel; prevent; programs; public health intervention; public health relevance; research study; response; spatiotemporal; tool; transmission process; trend; uptake

 DESCRIPTION: Scientific advances in HIV treatment have demonstrated that immediate access to combination antiretroviral therapy (ART) provides both individual and public health benefits. With sufficient uptake of ART, HIV-related morbidity, mortality and transmission can be drastically reduced at the population-level. As a result, the focus of global HIV control strategie have turned towards efforts to 'seek, test, treat and retain' people living with HIV (PLHIV) in ART. Emerging research on the cascade of HIV care, a simple metric tracking numbers of individuals infected, diagnosed, on ART and virally suppressed, has made clear that the control of the HIV epidemic hinges on the performance of health care systems in reaching and delivering care to PLHIV. Yet, as a surveillance tool, it provides an incomplete and possibly misleading basis for decisions on how to allocate funding. The US HIV epidemic is a diverse set of microepidemics, dispersed primarily across large urban centers with different underlying epidemiological and structural conditions. These disparate underlying conditions require localized strategies to optimize the HIV care cascade. Changes over time in these microepidemics, as well as in evidence on how to improve HIV testing and care, challenges our ability to make informed and timely decisions that result in the greatest health benefits for the resources invested in treating and preventing HIV. We propose a novel economic modeling framework to revolutionize HIV surveillance. This framework would ensure scarce resources are focused on interventions that can provide the greatest value for money in a given microepidemic. We will build upon a validated economic model to produce rapid, automated evidence synthesis, focusing on minimal data requirements to update the model, and integrate findings from emerging results of public health interventions into real-time disease surveillance systems. Experimental and observational studies of interventions to improve HIV testing and ART engagement have demonstrated their effectiveness in generalized and targeted populations, yet they are vastly underused in practice. Structural interventions for people who inject drugs (PWID), such as needle exchange and opioid agonist therapy (OAT), have proven incredibly valuable in jurisdictions with low barriers to these services, resulting in staggering declines in HIV incidence and disease burden. We hypothesize that a unique mix of these interventions will provide the best value for money in each micro epidemic, and that the optimal combinations will change over time according to underlying epidemic trends and the state of scientific advancement in HIV intervention research. We will demonstrate our approach for six distinct urban settings in the US with disparate structural conditions, substance use patterns, and HIV epidemics. This project is an innovative translational research initiative that will enhance surveillance efforts and increase the impact of interventional research in HIV and substance use disorders.

 描述：艾滋病毒治疗的科学进步表明，立即获得联合抗逆转录病毒治疗 (ART) 可以为个人和公众健康带来好处，通过充分利用抗逆转录病毒疗法，可以在人群水平上显着降低艾滋病毒相关的发病率、死亡率和传播率。因此，全球艾滋病毒控制战略的重点已转向通过抗逆转录病毒疗法“寻找、检测、治疗和留住”艾滋病毒感染者（PLHIV）。追踪受感染、诊断、接受抗逆转录病毒疗法和病毒抑制的人数的简单指标已经清楚地表明，艾滋病毒流行的控制取决于卫生保健系统在向艾滋病毒感染者提供护理方面的表现，但作为一种监测工具，它的表现却不尽如人意。美国艾滋病毒流行是一种多样化的微观流行病，主要分布在具有不同潜在流行病学和结构条件的大城市中心，这些不同的潜在条件需要采取本地化策略来解决。优化艾滋病毒护理级联随着时间的推移，这些微流行病的变化以及如何改进艾滋病毒检测和护理的证据，挑战了我们做出明智和及时决策的能力，从而使投资于治疗和治疗的资源获得最大的健康效益。我们提出了一个新颖的经济模型框架来彻底改变艾滋病毒监测，该框架将确保稀缺的资源集中在能够在特定的微流行病中提供最大价值的干预措施。 、自动证据合成、聚焦更新模型的最低数据要求，并将公共卫生干预措施的新结果整合到实时疾病监测系统中。改善艾滋病毒检测和抗逆转录病毒治疗参与的干预措施的实验和观察研究已经证明了它们在普通和目标人群中的有效性，然而，在实践中，针对注射吸毒者 (PWID) 的结构性干预措施，例如针头交换和阿片类激动剂治疗 (OAT)，在这些服务障碍较低的司法管辖区已被证明非常有价值，从而导致艾滋病毒大幅下降。发生率我们追求这些干预措施的独特组合将为每种微流行病提供最佳的性价比，并且最佳组合将根据潜在的流行趋势和艾滋病毒干预研究的科学进展状况而随着时间的推移而变化。我们将针对美国六种不同的城市环境展示我们的方法，这些城市具有不同的结构条件、物质使用模式和艾滋病毒流行情况。该项目是一项创新的转化研究计划，将加强监测工作并增加艾滋病毒和物质干预研究的影响。使用障碍。