Leveraging HIV care systems to improve cardiovascular disease prevention in the Kingdom of eSwatini

利用艾滋病毒护理系统改善埃斯瓦蒂尼王国的心血管疾病预防

• 批准号: 10700286
• 负责人: Anna Bershteyn
• 金额: $ 71.63万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700286
• 关键词: 1 year old; Acquired Immunodeficiency Syndrome; Active Learning; Address; Adult; Africa South of the Sahara; African; Age; Aging; Binding; Budgets; Cardiovascular Diseases; Caring; Cause of Death; Central Africa; Cessation of life; Chronic; Chronic Care; Chronic Kidney Failure; Community Health; Conflict (Psychology); Country; Diabetes Mellitus; Diagnosis; Disease; Eastern Africa; Enrollment; Epidemic; Equilibrium; Event; Face; Frequencies; Future; General Population; Generations; Goals; HIV; HIV-1; HIV/AIDS; Health; Health Benefit; Health Personnel; Health Policy; Health Resources; Health Services; Health system; Healthcare Systems; High Prevalence; Hour; Human Resources; Incidence; Individual; Interruption; Investments; Life Expectancy; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mental disorders; Modeling; Morbidity - disease rate; Natural Disasters; Onset of illness; Persons; Policies; Policy Making; Population Growth; Prevention; Preventive Health Services; Preventive care; Primary Prevention; Reading; Recommendation; Relaxation; Relaxation Therapy; Research; Resource Allocation; Resources; Risk; Self-Injurious Behavior; Services; Severities; Shock; Southern Africa; Time; Training; Violence; Viral Load result; Work; World Health Organization; antiretroviral therapy; cardiovascular disorder prevention; care delivery; care systems; caregiving; climate change; cost; demographics; design; epidemiological model; falls; health care delivery; health data; health economics; implementation science; improved; interest; mortality; pandemic disease; pandemic potential; population health; prevent; promote resilience; prospective; resilience; sex; supercomputer

ABSTRACT/SUMMARY ESwatini has the world’s highest prevalence of HIV, with more than one in four adults currently living with HIV. Extraordinary efforts at reducing the burden of HIV/AIDS have led eSwatini to become the first African country to surpass the UNAIDS “95-95-95” goals of diagnosing ≥95% of people living with HIV (PLHIV), providing treatment to ≥95% of those diagnosed, and achieving viral load suppression in ≥95% of those on treatment, leading to dramatic reductions in HIV mortality. In contrast, deaths from many non-communicable diseases (NCDs) in eSwatini are increasing. Deaths from cardiovascular disease, the second-leading cause of death after HIV/AIDS in eSwatini, have risen by 11% since 2000. Deaths from cancer, diabetes, chronic kidney disease, self-harm, and violence have increased by 12-35% over the same time period. Accordingly, the eSwatini Ministry of Health (MoH) is keenly interested in leveraging HIV care systems to improve care and prevention for cardiovascular disease and other high-burden NCDs. Due to resource constraints, not all NCD care can be provided to all residents of eSwatini, but a health benefits package (HBP) could be created to deliver the greatest possible health benefits within the limits of the country’s health budget and cadre of healthcare personnel. Additionally, like many other countries, eSwatini faces a growing risk of pandemics, conflict, and natural disasters due to population growth and climate change. These events can cause exogenous shocks that interrupt routine healthcare delivery, which may have implications for prioritizing which health services to offer. For example, investments in primary prevention may become a more efficient option than continuously delivering treatment for diseases when taking into consideration the likelihood of exogenous shocks to the healthcare system over coming decades. Our team combines expertise in modeling, health economics, HIV/NCD care integration, and eSwatini’s health system – including the current Director of Planning for the eSwatini Ministry of Health. Our study will (Aim 1) determine which non-HIV health services will be efficient to co-deliver with HIV care given the evolving demographics and health risks among people living with HIV in eSwatini, (Aim 2) determine which services to include in eSwatini’s HBP to maximize population health under resource constraints, and (Aim 3) assess trade-offs between health system efficiency and resilience to exogenous shocks such as pandemics, conflict, and natural disasters. Additionally, eSwatini is likely to be a forerunner of health policy questions to arise elsewhere in sub-Saharan Africa, where other countries are working to surpass the “95-95-95” treatment goals in coming years. Accordingly, we will disseminate results in the Eastern, Central, and Southern Africa Health Community to amplify the impact of our research and set the stage for future work.

摘要/总结 斯瓦蒂尼是世界上艾滋病毒感染率最高的国家，目前有超过四分之一的成年人感染艾滋病毒。 斯威士兰在减轻艾滋病毒/艾滋病负担方面做出了非凡努力，成为第一个非洲国家 超越联合国艾滋病规划署的“95-95-95”目标，即诊断出 ≥95% 的艾滋病毒感染者 (PLHIV)， ≥95% 的确诊患者接受治疗，并且 ≥95% 的接受治疗患者实现病毒载量抑制， 相比之下，许多非传染性疾病导致的死亡人数大幅下降。 埃斯瓦蒂尼的非传染性疾病（NCD）正在增加，心血管疾病是第二大死因。 埃斯瓦蒂尼的艾滋病毒/艾滋病自 2000 年以来增加了 11%。癌症、糖尿病、慢性肾病导致的死亡人数 相应地，疾病、自残和暴力在同一时期增加了 12-35%。 斯瓦蒂尼卫生部 (MoH) 对利用艾滋病毒护理系统来改善护理和 预防心血管疾病和其他高负担非传染性疾病 由于资源限制，并非所有非传染性疾病。 可以为埃斯瓦蒂尼的所有居民提供护理，但可以制定健康福利计划 (HBP) 在国家卫生预算和骨干力量范围内提供尽可能大的健康福利 此外，与许多其他国家一样，斯威士兰面临着越来越大的流行病风险。 人口增长和气候变化可能导致冲突和自然灾害。 中断常规医疗服务的外源性冲击可能会对优先考虑哪些因素产生影响 例如，对初级预防的投资可能成为更有效的选择。 考虑到外源性因素的可能性，而不是持续提供疾病治疗 我们的团队结合了建模、健康方面的专业知识。 经济、艾滋病毒/非传染性疾病护理一体化以及埃斯瓦蒂尼的卫生系统——包括现任主任 斯威士兰卫生部规划 我们的研究将（目标 1）确定哪些非艾滋病毒卫生服务。 鉴于人们不断变化的人口结构和健康风险，将有效地共同提供艾滋病毒护理 埃斯瓦蒂尼的艾滋病毒感染者，（目标 2）确定将哪些服务纳入埃斯瓦蒂尼的 HBP 中，以最大限度地发挥作用 资源限制下的人口健康，以及（目标 3）评估卫生系统效率之间的权衡 以及抵御流行病、冲突和自然灾害等外来冲击的能力。 可能是撒哈拉以南非洲其他地区出现卫生政策问题的先行者 各国正在努力在未来几年超越“95-95-95”的治疗目标。 在东部、中部和南部非洲卫生界传播结果，以扩大我们的影响 研究并为未来的工作奠定基础。