Adolescent-tailored HIV treatment and prevention strategies in South Africa: projecting clinical benefits and value

南非针对青少年的艾滋病毒治疗和预防策略：预测临床效益和价值

• 批准号: 10619497
• 负责人: Anne Neilan
• 金额: $ 83.08万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619497
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adolescence; Adolescent; Adolescent Medicine; Adolescent and Young Adult; Affect; Age; Age Factors; Antibodies; Antigens; Behavior; Budgets; Caring; Cessation of life; Chronic Disease; Clinical; Clinical Research; Clinical Trials; Clinical effectiveness; Collaborations; Cost Effectiveness Analysis; Data; Decision Making; Development; Diagnosis; Disclosure; Economic Models; Enrollment; Epidemic; Epidemiology; Event; Face; Female; Formulation; Foundations; Future; Genotype; Goals; HIV; HIV Infections; Health; Health Services Accessibility; Health behavior; Impulsivity; Incidence; Infection; Injectable; Intervention; Intervention Trial; Life Expectancy; Methods; Modality; Modeling; Monitor; Morbidity - disease rate; National Institute of Child Health and Human Development; Opportunistic Infections; Oral; Outcome; Persons; Pharmaceutical Preparations; Policies; Prevention; Prevention strategy; Public Health; Regimen; Resources; Risk Factors; Risk-Taking; Science; Sex Factors; South Africa; South African; Structure; Study models; Subgroup; System; Time; Toxic effect; United States; United States National Institutes of Health; Vaginal Ring; Viral Load result; Vulnerable Populations; Work; adolescent health outcomes; age group; antiretroviral therapy; base; cohort; cost; cost effective; cost effectiveness; experience; flexibility; health economics; improved; improved outcome; innovation; low and middle-income countries; male; models and simulation; mortality; novel; pill; pre-exposure prophylaxis; prevent; preventive intervention; sex; sexual relationship; social stigma; treatment strategy; uptake; young adult

PROJECT ABSTRACT Globally, HIV-related deaths have decreased 60% from their peak in 2004. Adolescents and young adults (AYA) ages 10 to 24, however, comprise the only age group that has not seen improvements in HIV-related mortality since then. Adolescence is a distinct developmental period, in which risk-taking and impulsive decision-making are normative behaviors. Stigma, disclosure concerns, and medication toxicity impact HIV health behaviors at a time when AYA may also experience their first sexual relationships. Differences in HIV health outcomes by age are partly due to late diagnosis, as well as to challenges in accessing treatment and prevention modalities requiring daily adherence. This problem is particularly acute in South Africa, which has the largest HIV epidemic in the world, with one in three new infections there occurring among AYA. Recent advances in long-acting HIV prevention and treatment formulations that avert the need to take a daily pill hold major promise, particularly for AYA. With support to Dr. Neilan from an NICHD K08 HD094638 (2018-2023) as well as from the Adolescent Medicine for HIV/AIDS Interventions Trials Network U24HD089880 (2017-2022), we developed the Cost-effectiveness of Preventing AIDS Complications-Adolescent and Young Adult (CEPAC- AYA) microsimulation model. We have conducted 12 model-based clinical and cost-effectiveness analyses addressing key questions in AYA HIV prevention, diagnosis, and treatment in the United States. In a new US- South Africa collaboration, we now propose to adapt and expand the structure of this simulation model and assemble necessary data inputs, and then to use the model to identify the most effective and cost-effective approaches and monitoring strategies for the treatment and prevention of HIV among AYA in South Africa. We have three specific aims: Aim 1. Develop new structure within the CEPAC-AYA model and derive data to permit modeling of long-acting ART and PrEP regimens for AYA in South Africa. Aim 2. Evaluate the clinical impact, cost, and cost-effectiveness of new AYA-focused treatment interventions to decrease opportunistic infections and mortality among AYA in South Africa. Aim 3. Assess the clinical impact, cost, and cost-effectiveness of new AYA-focused prevention interventions to reduce HIV incidence among AYA in South Africa. The goal of this proposal is to evaluate context-specific, adolescent-tailored care strategies and to identify the best use of limited resources to improve health outcomes for AYA affected by HIV in South Africa. As new treatments and delivery systems emerge, the model will be poised to inform how to best deploy these resources for this vulnerable population.

项目摘要 在全球范围内，与HIV相关的死亡人数比2004年的峰值下降了60％。青少年和年轻人 （AYA）10至24岁，是唯一没有看到与HIV相关的年龄组 从那以后的死亡率。青春期是一个独特的发展时期，在这种发展时期 决策是规范行为。污名，披露问题和药物毒性影响艾滋病毒 在AYA也可能经历他们的第一个性关系的时候，健康行为。艾滋病毒的差异 按年龄划分的健康结果部分是由于诊断后期造成的，以及获得治疗和治疗方面的挑战 需要每天遵守的预防方式。这个问题在南非特别严重， 世界上最大的艾滋病毒流行病，其中有三分之一的新感染发生在艾亚。最近的 长效艾滋病毒预防和治疗配方的进步，避免需要每日药丸 主要的希望，特别是对艾亚。在NICHD K08 HD094638（2018-2023）的NICHD K08 HD094638（2018-2023）的支持下 以及来自艾滋病毒/艾滋病干预试验的青少年医学网络U24HD089880（2017-2022）， 我们开发了预防艾滋病并发症 - 青年和年轻人的成本效益（cepac-- AYA）微仿真模型。我们已经进行了12个基于模型的临床和成本效益分析 在美国解决AYA HIV预防，诊断和治疗中的关键问题。在新的美国 南非合作，我们现在建议适应和扩展该模拟模型的结构和 组装必要的数据输入，然后使用该模型来确定最有效，最具成本效益的 南非AYA中AYA的治疗和预防HIV的方法和监测策略。我们 有三个特定的目标： 目标1。在CEPAC-AYA模型中开发新结构，并得出数据以允许建模 南非AYA的长效艺术和准备方案。 目标2。评估新的以AYA为中心的治疗的临床影响，成本和成本效益 南非AYA的机会主义感染和死亡率的干预措施。 目标3。评估新型AYA预防的临床影响，成本和成本效益 减少南非AYA的艾滋病毒发病率的干预措施。 该建议的目的是评估特定于上下文的青少年护理策略，并确定 最好使用有限的资源来改善南非受艾滋病毒影响的AYA的健康状况。作为新 该模型将有望告知如何最好地部署这些治疗和交付系统 这个脆弱人群的资源。