Tobacco Use and Cessation, HIV, and TB in South Africa: Clinical and Economic Outcomes

南非的烟草使用和戒烟、艾滋病毒和结核病：临床和经济成果

• 批准号: 10080873
• 负责人: Krishna P Reddy
• 金额: $ 72.89万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10080873
• 关键词: Accounting; Address; Adult; Area; Behavior; Behavioral; Cardiovascular Diseases; Caring; Cause of Death; Clinical; Clinical Trials; Cohort Studies; Collaborations; Communities; Cost Effectiveness Analysis; Costs and Benefits; Country; Data; Databases; Disease; Economic Burden; Effectiveness of Interventions; Epidemic; Epidemiology; Ethics; Face; Funding Opportunities; Future; Goals; Guidelines; HIV; HIV/TB; Health; Health Care Costs; Health Policy; Health behavior; Income; Institution; International; Intervention; Investigation; Life; Life Expectancy; Light; Logistics; Malignant Neoplasms; Methods; Modeling; Natural History; Outcome; Policies; Prevention; Public Health; Publishing; Recording of previous events; Reporting; Research; Research Personnel; Resources; Risk; Scientist; South Africa; South African; Structural Models; Time; Tobacco; Tobacco Use Cessation; Tobacco smoke; Tobacco smoking behavior; Tobacco use; Training; Treatment outcome; Tuberculosis; United States National Institutes of Health; antiretroviral therapy; base; budget impact; care delivery; care outcomes; care systems; clinical investigation; clinically relevant; cohort; comorbidity; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; design; economic cost; economic evaluation; economic impact; economic outcome; evidence base; experience; global health; health care service; health care service utilization; health economics; health organization; high risk; innovation; intervention effect; low and middle-income countries; models and simulation; multidisciplinary; novel; population based; response; social; synergism; tobacco cessation intervention; tobacco control; tuberculosis treatment

PROJECT SUMMARY Global health organizations have called for integrating tobacco control into HIV and tuberculosis (TB) responses. Tobacco use worsens health outcomes of people with HIV, including conferring higher risks of TB and of noncommunicable diseases such as cardiovascular disease and cancer. How to most effectively and efficiently incorporate tobacco control into HIV and TB care remains unclear; resource constraints necessitate thoughtful and evidence-based planning. Determining which interventions are most effective and cost-effective, and how to combine delivery approaches for optimal outcomes, is critically important for informing clinical guidelines. This requires understanding the benefits and costs of various interventions, which cost- effectiveness modeling is specifically designed to address. The overall goal of this proposal is to promote an evidence-based approach to decisions surrounding the integrated care and services for the overlapping tobacco, HIV, and TB epidemics in low- and middle-income countries (LMICs). Tobacco use and cessation behaviors in LMICs may differ from those in high-income countries and can influence the effectiveness of interventions. In this proposal, we will focus on South Africa, a country with colliding tobacco, HIV, and TB epidemics. Our research plan includes: developing an integrated simulation model of tobacco, HIV, and TB; parameterizing the model with behavioral, clinical, and cost data from a community-based population cohort in South Africa and from other databases and studies; projecting clinical and economic outcomes associated with tobacco use and cessation among people with HIV; and conducting model-based cost-effectiveness analysis of tobacco cessation interventions, including those combined with other HIV and TB care interventions. This proposal brings together internationally recognized experts in fields that are complementary for the project, including clinical policy-relevant HIV and TB simulation modeling, health behaviors, tobacco treatment interventions, and epidemiology of HIV and comorbidities in South Africa. The investigators and institutions have a history of highly productive collaboration. The innovative model will be the first to integrate tobacco, HIV, and TB. The methods are highly significant and crucial for addressing questions around cost- effectiveness and policies for integrating tobacco cessation with HIV and TB care. The model structure will enable future analyses of tobacco cessation interventions in other settings, establishing a broad, durable framework for policy-relevant clinical and health economic analyses.

项目概要 全球卫生组织呼吁将烟草控制纳入艾滋病毒和结核病 (TB) 回应。吸烟会使艾滋病毒感染者的健康状况恶化，包括增加患结核病的风险 以及心血管疾病和癌症等非传染性疾病。如何最有效和 有效地将烟草控制纳入艾滋病毒和结核病护理尚不清楚；资源限制需要 深思熟虑且基于证据的规划。确定哪些干预措施最有效且最具成本效益， 以及如何结合交付方法以获得最佳结果，对于告知临床至关重要 指导方针。这需要了解各种干预措施的收益和成本，这些干预措施的成本 有效性建模是专门为解决这一问题而设计的。 该提案的总体目标是促进基于证据的决策方法 针对低收入和中等收入地区重叠的烟草、艾滋病毒和结核病流行病的综合护理和服务 国家（中低收入国家）。中低收入国家的烟草使用和戒烟行为可能与高收入国家不同 国家并可以影响干预措施的有效性。在本提案中，我们将重点关注南非 烟草、艾滋病毒和结核病流行相互冲突的国家。我们的研究计划包括：开发一个综合的 烟草、艾滋病毒和结核病的模拟模型；使用行为、临床和成本数据对模型进行参数化 来自南非基于社区的人口队列以及其他数据库和研究；投射 艾滋病毒感染者与吸烟和戒烟相关的临床和经济结果；和 对戒烟干预措施进行基于模型的成本效益分析，包括 与其他艾滋病毒和结核病护理干预措施相结合。 该提案汇集了互补领域的国际公认专家 项目，包括临床政策相关的艾滋病毒和结核病模拟模型、健康行为、烟草治疗 南非艾滋病毒和合并症的干预措施和流行病学。调查人员和机构 拥有高效合作的历史。该创新模式将首次将烟草、 艾滋病毒和结核病。这些方法对于解决有关成本的问题非常重要且至关重要 将戒烟与艾滋病毒和结核病护理相结合的有效性和政策。模型结构将 使未来能够对其他环境下的戒烟干预措施进行分析，建立广泛、持久的 政策相关临床和卫生经济分析框架。