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，立即获得抗逆转录病毒疗法（ART）提供了个人和公共卫生益处。通过足够的ART吸收，与HIV相关的发病率，死亡率和传播可以大大降低。结果，全球艾滋病毒控制策略的重点已转向“寻求，测试，治疗和保留”艾滋病毒（PLHIV）（PLHIV）的努力。关于艾滋病毒级联护理的新兴研究是一种简单的指标跟踪数量，被感染，被诊断为艺术和几乎被抑制的个体，已经明确指出，对艾滋病毒流行病的控制对医疗保健系统的表现进行了控制，以达到PLHIV的到达和提供护理。但是，作为一种监视工具，它为如何分配资金提供了不完整且可能的误导性基础。美国艾滋病毒的流行是一系列微观性，主要分散在具有不同基础流行病学和结构状况不同的大型城市中心。这些不同的潜在条件需要局部策略来优化HIV护理级联。随着时间的流逝，这些微观性学以及有关如何改善艾滋病毒测试和护理的证据，挑战了我们做出明智和及时的决定的能力，从而为用于治疗和预防艾滋病毒的资源带来了最大的健康益处。我们提出了一个新颖的经济建模框架，以彻底改变艾滋病毒监测。该框架将确保稀缺的资源集中在干预措施上，这些干预措施可以在给定的微型流行病中提供最大价值。我们将建立在经过验证的经济模型的基础上，以生成快速，自动化的证据综合，重点介绍最小数据要求，以更新模型，并从新兴的公共卫生干预结果中综合发现到实时疾病监视系统中。对改善艾滋病毒测试和艺术参与的干预措施的实验性和观察性研究表明，它们在广义和有针对性的人群中的有效性，但实际上在实践中经历了大量的经历。对注入药物（PWID）的人（例如针交换和阿片类动力学疗法（OAT））的结构性干预已被证明在这些服务较低障碍的司法管辖区中非常有价值，从而导致艾滋病毒事件和疾病伯恩的障碍下降。我们假设这些干预措施的独特组合将为每种微观流行病提供最佳价值，并且根据潜在的流行病趋势和HIV干预研究中科学进步的状态，最佳组合会随着时间而变化。我们将通过不同的结构条件，吸毒模式和艾滋病毒流行病来展示我们在美国六个不同的城市环境的方法。该项目是一项创新的翻译研究计划，它将加强监视工作，并增加介入研究对艾滋病毒和药物使用障碍的影响。