PEARL 2.0: The impact of the Ending the HIV Epidemic initiative and risk factor interventions on the projected multimorbidity burden and healthcare costs for people aging with HIV in the United States

PEARL 2.0：“结束艾滋病毒流行”倡议和风险因素干预措施对美国艾滋病毒感染者的预计多重病负担和医疗保健费用的影响

• 批准号: 10632482
• 负责人: Keri Nicole Althoff
• 金额: $ 73.48万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10632482
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; African American; African American population; Age; Age Distribution; Aging; American; Black race; Budgets; Cardiovascular Diseases; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Clinical Management; Clinical Services; Collaborations; Computer Simulation; Cost Analysis; Data; Decision Making; Economic Models; Effectiveness of Interventions; Elderly; Epidemic; Epidemiology; Ethnic Origin; Funding; Future; Geriatrics; Goals; Government; Guidelines; HIV; HIV diagnosis; Health; Health Care Costs; Health Services; Health system; Healthcare; Healthcare Systems; Heterosexuals; Hispanic; Hispanic Populations; Intervention; Kidney Diseases; Life Expectancy; Link; Malignant Neoplasms; Modeling; Obesity; Outcome; Overweight; Persons; Policies; Polypharmacy; Population Heterogeneity; Prevention; Privatization; Race; Research; Research Design; Research Priority; Resource Allocation; Resources; Risk; Risk Factors; Shapes; Smoking; Subgroup; Testing; United States; United States National Institutes of Health; Update; Weight Gain; Weight maintenance regimen; Woman; antiretroviral therapy; care costs; cigarette smoking; clinical care; clinical decision-making; cohort; comorbidity; cost; cost effective intervention; cost effectiveness; cost estimate; cost-effectiveness evaluation; cost-effectiveness ratio; diabetes risk; end stage liver disease; experience; federal policy; health disparity; health inequalities; improved; incremental cost-effectiveness; injection drug use; men; men who have sex with men; models and simulation; multidisciplinary; multiple chronic conditions; risk sharing; sex; simulation; smoking cessation; surveillance data; weight maintenance

PROJECT SUMMARY Within the next decade, nearly 1 million people aging with HIV (PAH) using antiretroviral therapy (ART) in the United States (US) will experience multi-decade life expectancy. The goal of this project is to build a suite of modules to further the ProjEcting Age, multimoRbidity and poLypharmacy (PEARL) computer simulation model’s capacity to inform clinical decision-making and resource allocation in governmental and private healthcare systems in efforts meet the future needs of caring for PAH. The Ending the HIV Epidemic (EHE) efforts will undoubtedly re-shape the age distributions of Black/African American (AA), Hispanic, and White PAH within sex-and-HIV acquisition risk groups. Projections under various scenarios of EHE goal attainment strategies within these subgroups are needed to answer the question: “How will EHE efforts impact the number of older PAH (who need clinical care) over the next two decades?” As PAH experience a greater burden of multimorbidity than people without HIV, and disparities persist within PAH subgroups, it is essential to intervene upon shared risk factors for numerous comorbidities, such as cigarette smoking and obesity. It is pertinent to answer the questions “Can interventions on shared risk factors for numerous comorbidities reduce future multimorbidity in PAH in the US, and are such interventions cost- effective?” Smoking cessation and weight maintenance in the first 24 months after ART initiation may reduce the risk of future multimorbidity with present-day clinical and administrative decision-making. Finally, by investigating the question “What are the future healthcare costs for caring for PAH in the US over the next 2 decades?” clinical directors, health systems and state and federal policy decision-makers can prepare for costs and select cost effective interventions. The established PEARL modeling team will (a) collaborate closely with Johns Hopkins HIV Epidemic Economic Model (JHEEM) team to construct a module to simulate the impact of EHE efforts, (b) continue their beneficial partnership with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to construct a risk factor intervention module, and (c) construct a costing module to achieve the following among 15 PAH subgroups using ART in the US through 2040: AIM 1: To simulate the impact of EHE goals on the projected number and age distribution. AIM 2: To project the change in the multimorbidity burden with risk factor interventions. AIM 3: To estimate the cost effectiveness of interventions and project HIV- and non-HIV-related healthcare costs. The proposed aims align with the research priorities of the 2021-25 Trans-NIH Plan for HIV and HIV-Related Research and include Multidisciplinary Studies of HIV/AIDS and Aging (PAR-21-068) priority outcomes. Findings will provide key HIV epidemiologic, clinical, and health services data within 15 PAH subgroups to guide clinical management and informing healthcare resource allocations to ultimately improve the health of PAH in the US.

项目摘要 在接下来的十年中，使用抗逆转录病毒疗法（ART）在接下来的十年中 美国（美国）将体验多年的预期寿命。该项目的目的是建造一套 模块以进一步预测年龄，多种病态和多功能（Pearl）计算机模型的模型 为政府和私人医疗保健中的临床决策和资源分配提供信息的能力 努力的系统满足了照顾PAH的未来需求。 艾滋病毒流行（EHE）的结局无疑会重新塑造黑人/非洲的年龄分布 美国（AA），西班牙裔和白色PAH在性别和hiv获取风险群体中。在各种下的预测 需要在这些子组中实现目标实现策略的方案来回答以下问题：“如何 EHE的努力会影响未来二十年的老PAH（需要临床护理）的数量吗？” 由于PAH经历了比没有艾滋病毒的人更大的多种病情燃烧，并且差距持续存在 PAH亚组，必须干预共同的风险因素，以获取多种合并症，例如香烟 吸烟和肥胖。有必要回答“可以干预共同风险因素的问题 许多合并症降低了美国PAH的未来多种病态，这种干预措施成本 - 有效吗？ 未来多种多发性的风险以及当今的临床和行政决策。最后，by 调查一个问题：“在下一个美国照顾PAH的未来医疗保健费用是多少 20年？”临床主管，卫生系统以及州和联邦政策决策者可以为 成本并选择具有成本效益的干预措施。 既定的珍珠建模团队将（a）与约翰·霍普金斯艾滋病毒流行经济紧密合作 模型（JHEEM）团队构建一个模块以模拟EHE努力的影响，（b）继续他们的好处 与北美艾滋病研究与设计（NA-Accord）合作的合作 构建风险因素干预模块，（c）构建一个成本核算模块，以实现以下内容 15个PAH亚组在美国直到2040年使用艺术： 目标1：模拟目标目标对预计数字和年龄分布的影响。 AIM 2：通过风险因素干预措施预测多发病燃烧的变化。 目标3：估计干预措施的成本效益以及与HIV和非HIV相关的医疗保健成本的成本效益。 拟议的目的与2021 - 25年艾滋病毒和HIV相关的2021-25 Trans-NIH计划的研究重点保持一致 研究并包括艾滋病毒/艾滋病和衰老的多学科研究（PAR-21-068）优先级。发现 将在15个PAH亚组中提供关键的HIV流行病学，临床和健康服务数据，以指导临床 管理和告知医疗资源分配，以最终改善美国PAH的健康状况。