The CHARMED model: a multimorbidity simulation model for people aging with HIV

CHARMED 模型：针对艾滋病毒老年患者的多发病模拟模型

基本信息

批准号：
10790700
负责人：
Emily Parker Hyle
金额：
$ 41.18万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10790700
关键词：
Acquired Immunodeficiency Syndrome Address Administrative Supplement Advocate Age Age Years Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Area Award Cardiovascular Diseases Caring Clinical Clinical Research Clinical Trials Cohort Studies Collaborations Cost Effectiveness Analysis Cost of Illness Data Dementia Development Diagnosis Disease Diverse Workforce Economics Epidemiology Etiology Event Funding Future General Population Goals Grant HIV HIV/AIDS Health Care Costs Heart High School Student Impaired cognition Individual International Internships Intervention Investigation Investments Learning Life Expectancy Medicine Mental Depression Mental Health Mentors Mentorship Modeling Morbidity - disease rate NIH Office of AIDS Research National Institute on Aging Neurocognitive Outcome Parents Patients Persons Policies Prevention Prevention strategy Public Health Quality of life Recording of previous events Research Research Methodology Research Personnel Research Priority Research Project Grants Research Training Risk Risk Factors Students Time Training Treatment Effectiveness Underserved Population United States aged antiretroviral therapy care costs clinical care clinically relevant cohort college community college comorbidity cost cost effective cost effectiveness dementia risk design economic outcome effective therapy evidence base experience high risk high school improved interest models and simulation modifiable risk mortality mortality risk multidisciplinary multiple chronic conditions novel parent grant prevent programs supportive environment synergism training opportunity undergraduate student

项目摘要

PROJECT SUMMARY Almost half of all people diagnosed with HIV in the United States are aged 50 or older and are at increased risk for dementia and multimorbidity. Dementia is of major clinical policy concern because it results in inexorable clinical decline and extremely high costs of care. People with HIV are at particularly high risk because they often have major risk factors for the development of traditional etiologies of dementia, such as Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD), and they also have a risk of HIV-associated neurocognitive disease (HAND) despite sustained virologic suppression. Depression, cardiovascular disease (CVD), and HIV are known to have potent synergies that contribute to the development of dementia. These comorbidities are modifiable risk factors for dementia that are highly prevalent, known to be undertreated in people with HIV, and likely to be clinically and economically important for prevention and management. The overall goal of this proposal is to provide an evidence-based approach for prioritizing and advocating for interventions to improve the quality of life and reduce morbidity and mortality among people aging with HIV. The benefits of reducing the burden of depression and CVD among people with HIV may currently be underestimated, given that concomitant benefits related to multimorbidity are often not captured due to short durations of observational or trial data. Determining which interventions are most clinically effective and cost- effective is critically important to understand so that people aging with HIV can benefit from strategies to reduce their risk of dementia and multimorbidity as they age. We propose to: 1) develop the Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia (CHARMED) Model, including populating the model with clinical and outcomes data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and nationally-representative cost data; 2) project clinical and economic outcomes of people aging with HIV; and 3) perform cost-effectiveness analyses of targeted interventions to reduce the burden of depression and CVD and to quantify the resultant reduction in dementia and multimorbidity. In this supplement, we outline the development of the HIV/Aging Internship Program: unique, paid internship opportunities for high school and undergraduate students from backgrounds underrepresented in Medicine and Public Health (URiM/URiPH). We propose internships in two areas of focus: 1) Research Methods, and 2) Research Administration. In the Research Methods internship, each student will be paired with an investigator (MD or PhD) with a focused research question. In the Research Administration internship, each student will experience training opportunities with multiple mentors, including: program management, clinical research coordination, and primary investigation. All research projects will be within scope of the funded parent grant; the upfront investment from the one-year supplement will allow for the development of a program that is sustainable for the future.

项目概要在美国，几乎一半被诊断出感染艾滋病毒的人年龄在 50 岁或以上，并且面临更高的风险痴呆症和多发病是临床政策的主要关注点，因为它会导致不可避免的后果。临床衰退和极高的护理费用艾滋病毒感染者面临特别高的风险，因为他们通常具有导致痴呆症（例如阿尔茨海默氏症）传统病因的主要危险因素疾病和阿尔茨海默氏病相关痴呆症 (AD/ADRD)，并且还有感染 HIV 相关的风险尽管持续病毒学抑制，但仍出现神经认知疾病（HAND）抑郁症、心血管疾病。众所周知，CVD 和 HIV 具有强大的协同作用，有助于痴呆症的发展。合并症是痴呆症的可改变的危险因素，在痴呆症中非常普遍，但已知治疗不足。艾滋病毒感染者，并且可能对预防和管理具有临床和经济上的重要意义。该提案的总体目标是提供一种基于证据的方法来确定优先顺序并倡导旨在改善艾滋病毒感染者的生活质量并降低发病率和死亡率的干预措施。目前，减轻艾滋病毒感染者抑郁症和心血管疾病负担的好处可能是被低估了，因为与多病相关的伴随效益往往由于时间短而未被捕获确定观察或试验数据的持续时间，哪些干预措施在临床上最有效且成本最低。了解有效性至关重要，这样老年艾滋病毒感染者才能从以下策略中受益：随着年龄的增长，降低他们患痴呆症和多种疾病的风险。我们建议：1）发展认知能力。损伤、艾滋病毒、衰老、心脏、心理健康和痴呆 (CHARMED) 模型，包括填充模型包含来自北美艾滋病队列研究合作的临床和结果数据设计 (NA-ACCORD) 和全国代表性成本数据 2) 项目临床和经济成果；感染艾滋病毒的老年人；3) 对有针对性的干预措施进行成本效益分析，以减少抑郁症和心血管疾病的负担，并量化由此产生的痴呆症和多种疾病的减少。在本增刊中，我们概述了艾滋病毒/老龄化实习计划的发展：独特的带薪实习为医学和医学领域代表性不足的高中生和本科生提供机会公共卫生（URiM/URiPH）。我们建议在两个重点领域进行实习：1）研究方法，2）在研究方法实习中，每个学生将与一名调查员配对。（医学博士或博士）在研究管理实习中，每个学生都会有一个重点研究问题。体验多位导师的培训机会，包括：项目管理、临床研究所有研究项目都将在家长资助的范围内；一年期补助的前期投资将用于制定一个计划，该计划未来可持续发展。