Prospects for hepatitis C elimination in networks of people who inject drugs through improvements in the care continuum

通过改善护理连续性在注射吸毒者网络中消除丙型肝炎的前景

• 批准号: 10591937
• 负责人: Lin Zhu
• 金额: $ 18.01万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591937
• 关键词: Affect; Antiviral Therapy; Attention; Award; Bayesian Method; Calibration; Caring; Characteristics; Collaborations; Communicable Diseases; Communication; Complex; Complication; Continuity of Patient Care; Economics; Effectiveness; Effectiveness of Interventions; Environment; Evaluation; Foundations; Goals; HIV; HIV Infections; HIV/HCV; Health; Health Policy; Hepatitis C; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Heterogeneity; Individual; Infection; Infrastructure; Injecting drug user; Injections; Intervention; Knowledge; Leadership; Life; Mathematics; Meta-Analysis; Mission; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Needle-Exchange Programs; Network-based; Outcome; Pathway interactions; Policy Making; Population; Prognosis; Public Health; Research; Research Personnel; Research Training; Risk; Route; Services; Sex Behavior; Structure; Testing; Time; Training; Treatment Efficacy; Treatment outcome; Trust; United States National Institutes of Health; Variant; Viral; Work; career; co-infection; collaborative environment; cost effective; cost effectiveness; design; disability; disorder control; effective intervention; effectiveness evaluation; efficacy evaluation; evidence base; health economics; improved; improved outcome; medical schools; models and simulation; network models; novel; rural area; skill acquisition; skills; social; social determinants; social vulnerability; societal costs; systematic review; therapy design; transmission process; uptake; urban area

Project Summary/Abstract People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the U.S. Improving the HCV care continuum, with particular attention to the complication of HIV-coinfection, is critical to achieving HCV elimination. Heterogeneous injection and sexual networks among PWID can significantly affect HCV and HIV transmission and intervention outcomes. Although empirical studies on the efficacy of interventions to improve the HCV care continuum in the direct-acting antiviral (DAA) era have begun to accumulate, there remains a lack of understanding of the population level impact and cost-effectiveness of these interventions to inform policymaking. My long-term goal is to develop mathematical and statistical simulation models to inform health policies relating to infectious disease control. The overall objective for this application, which is a critical step toward attaining my long-term goal, is to develop a dynamic agent- based network model of HCV and HIV transmission among PWID, to determine the population-level impact and cost-effectiveness of interventions to improve the HCV care continuum. My central hypothesis is that interventions that target multiple stages of the care continuum, taking account of individual characteristics, service environment, and meso/macro-level contexts, will have significant population-level impact in decreasing HCV and HIV infections and associated complications while being cost-effective. The central hypothesis will be tested by pursuing three specific aims: 1) Identify social determinants of the HCV care continuum outcomes among PWID, and effective interventions to improve these outcomes in the DAA era; 2) Determine the population-level impact and cost-effectiveness of different interventions to improve the HCV care continuum among PWID; 3) Identify the determinants of differences in population-level impact of interventions to improve the HCV care continuum based on specific features of PWID networks. I will pursue these aims using systematic review and meta-analysis (Aim 1), expanding our model of HCV transmission via injection network to incorporate sexual network and HIV transmission (Aim 2), and fitting the model to different PWID networks and evaluate impact across the networks (Aim 3). To complete the research and advance my career, I will obtain research training in evidence synthesis, Bayesian methods for model calibration, and health economics, and professional training in scientific communication, leadership, and collaboration, in the interdisciplinary environment of the Department of Health Policy at the Stanford School of Medicine. The expected outcome is a novel model platform to evaluate complex HIV/HCV intervention strategies for improving the health of PWID. The proposed research is significant because the results will provide systematic understanding of social determinants of HCV care in PWID and essential evidence on the population-level impact and cost-effectiveness of interventions to improve the HCV care continuum in different PWID populations to inform policymaking on HCV elimination.

项目摘要/摘要 注射药物（PWID）的人会说明美国大多数丙型肝炎病毒（HCV）感染 改善HCV护理连续体，特别关注HIV-CoIntection的并发症，至关重要 实现HCV消除。 PWID中的异质注入和性网络可以显着 影响HCV和HIV传播和干预结果。尽管关于 改善直接作用抗病毒（DAA）时代HCV护理连续体的干预措施已开始 积累，仍然缺乏对人口水平的影响和成本效益的了解 这些干预措施为决策提供了信息。我的长期目标是发展数学和统计 模拟模型，以告知与传染病控制有关的健康政策。总体目标 该应用程序是实现我的长期目标的关键一步，是开发动态代理 - PWID之间基于HCV和HIV传播的网络模型，以确定人口水平的影响 干预措施的成本效益，以改善HCV护理连续体。我的中心假设是 考虑到个人特征，针对多个护理连续体的多个阶段的干预措施， 服务环境以及中元/宏观环境将对人口级别产生重大影响 降低HCV和HIV感染以及相关并发症，同时具有成本效益。中央 假设将通过追求三个具体目标来检验：1）确定HCV护理的社会决定因素 PWID之间的连续性结果，以及在DAA时代改善这些结果的有效干预措施； 2）确定不同干预措施的人口水平的影响和成本效益以改善 PWID之间的HCV护理连续性； 3）确定人口水平差异影响的决定因素 根据PWID网络的特定特征改善HCV护理连续体的干预措施。我会 使用系统的审查和荟萃分析来追求这些目标（AIM 1），扩大了我们的HCV模型 通过注射网络传输以合并性网络和HIV传播（AIM 2），并配合 到不同的PWID网络的模型并评估整个网络的影响（AIM 3）。完成 研究和进步我的职业生涯，我将获得证据综合的研究培训，贝叶斯方法 用于模型校准，健康经济学以及科学交流的专业培训， 在卫生政策部跨学科环境中的领导和协作 斯坦福大学医学院。预期结果是评估复合物的新型模型平台 HIV/HCV干预策略，以改善PWID的健康状况。拟议的研究很重要 因为结果将对PWID和 有关人口级别影响和干预措施的成本效益的基本证据以改善 HCV护理连续性在不同的PWID种群中，以告知HCV消除的决策。