Optimizing HIV Care in Less Developed Countries

优化欠发达国家的艾滋病毒护理

• 批准号: 10580906
• 负责人: Kenneth Alan Freedberg
• 金额: $ 105.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580906
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Budgets; Caring; Characteristics; Clinical; Clinical Trials; Computers; Country; Data; Developing Countries; Development; Epidemic; Face; Goals; Guidelines; HIV; HIV Infections; HIV/AIDS; Health; Human immunodeficiency virus test; Incidence; Instruction; International; Intervention; Methods; Modeling; Morbidity - disease rate; NIH Office of AIDS Research; Natural History; Outcome; Persons; Policies; Policy Maker; Population; Prevention; Reduce health disparities; Research; Research Priority; Resource-limited setting; Resources; Testing; antiretroviral therapy; clinical care; clinical implementation; cost; cost effectiveness; experience; high risk population; improved; innovation; insight; mortality; novel; pandemic disease; prevent; preventive intervention; research study; simulation; skills; treatment guidelines; treatment response

Despite major advances in treatment and prevention of HIV infection, the HIV/AIDS pandemic continues to cause tremendous morbidity and mortality. Of the 37.7 million people living with HIV worldwide, only 73% are receiving antiretroviral therapy. In 2020 alone, an estimated 680,000 people died from AIDS-related illness, and nearly two million people are newly infected with HIV each year. The HIV burden is highest in parts of the world that face the additional challenge of highly constrained resources. HIV testing and treatment guidelines have continually evolved; however, assessing the benefits associated with improved testing, more effective antiretroviral therapy, and increasingly effective prevention interventions is difficult. It is unclear which specific strategies and overall approach would be most effective for specific populations, given the critical reality of budget constraints. This competing continuation proposes to expand upon the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer microsimulation of the natural history, management, outcomes, costs, and cost-effectiveness of HIV clinical care. This proposal includes cutting-edge, guideline-informing studies of novel treatments and development of innovative modeling optimization methods to advance the field. There are two specific aims: Specific Aim 1: To expand the CEPAC-I microsimulation to address new clinical policy questions focused on key populations, using data from recent clinical trials and implementation research studies. Specific Aim 2: To expand upon the optimization model and better determine the combination of HIV care interventions that most decreases HIV incidence in countries with different epidemic characteristics and resource constraints. In close alignment with the 2022 research priorities of the NIH Office of AIDS Research, the goals of this proposal include reducing HIV incidence, identifying optimal prevention and treatment responses, and reducing health disparities by improving key population outcomes. The assembled research team has the ideal combination of skills and experience to address critical questions around the cost-effectiveness of new interventions for HIV in high-risk populations. The results will lead to new insights to inform clinicians and policymakers, leading to improved HIV treatment guidelines in multiple resource-limited settings. RELEVANCE (See instructions): People living with HIV/AIDS remain untreated and more become newly infected each year. Many testing, treatment, and prevention methods exist, raising critically important questions about which strategies to employ when, where, and for whom, given varying epidemic features and resource constraints. We will expand the CEPAC-I Model to address questions related to the impact of novel treatment and prevention options and to determine which combinations of interventions will optimize HIV health outcomes globally.

尽管在治疗和预防艾滋病毒感染方面取得了重大进展，但艾滋病毒/艾滋病的流行仍在继续 造成巨大的发病率和死亡率。在全世界 3770 万艾滋病毒感染者中，只有 73% 正在接受抗逆转录病毒治疗。仅 2020 年，估计就有 68 万人死于此病 与艾滋病相关的疾病，每年有近 200 万人新感染艾滋病毒。艾滋病毒负担 在世界上面临资源高度有限的额外挑战的地区是最高的。艾滋病病毒 检测和治疗指南不断发展；然而，评估相关的好处 改进的检测、更有效的抗逆转录病毒治疗以及日益有效的预防 干预是困难的。目前尚不清楚哪种具体策略和总体方法最有效 鉴于预算限制的严峻现实，对特定人群有效。 这一相互竞争的延续提议扩大预防艾滋病的成本效益 Complications International (CEPAC-I) 模型，自然历史的计算机微观模拟， HIV 临床护理的管理、结果、成本和成本效益。该提案包括 对新疗法和创新模型开发的前沿、指导性研究 推进该领域发展的优化方法。具体目标有两个： 具体目标 1：扩展 CEPAC-I 微观模拟以解决重点关注的新临床政策问题 使用最近的临床试验和实施研究的数据针对重点人群。 具体目标 2：扩展优化模型并更好地确定 HIV 护理组合 在具有不同流行特征的国家中，采取最能降低艾滋病毒发病率的干预措施， 资源限制。 该项目的目标与 NIH 艾滋病研究办公室 2022 年的研究重点密切一致 提案包括减少艾滋病毒发病率、确定最佳预防和治疗对策，以及 通过改善关键人群的结果来减少健康差距。组建的研究团队拥有 技能和经验的理想结合，解决围绕成本效益的关键问题 针对高危人群中艾滋病毒的新干预措施。结果将为临床医生带来新的见解 和政策制定者，从而改善多个资源有限环境中的艾滋病毒治疗指南。 相关性（参见说明）： 艾滋病毒/艾滋病感染者仍未得到治疗，而且每年都有更多的新感染者。多次测试， 治疗和预防方法是存在的，这提出了至关重要的问题：采取哪些策略 考虑到不同的流行病特征和资源限制，何时、何地、为谁使用。我们将 扩展 CEPAC-I 模型以解决与新型治疗和预防的影响相关的问题 选项并确定哪些干预措施组合将优化全球艾滋病毒健康结果。