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

基本信息

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
项目类别：
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

项目摘要

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，与艾滋病毒相关的死亡人数比 2004 年的峰值下降了 60%。青少年和年轻人 (AYA) 然而，10 至 24 岁的人群是唯一一个在艾滋病毒相关方面未见改善的年龄组。从那时起的死亡率。青春期是一个独特的发展时期，在这个时期，冒险精神和冲动倾向决策是规范行为。耻辱、披露问题和药物毒性影响艾滋病毒 AYA 也可能经历第一次性关系时的健康行为。艾滋病毒的差异按年龄划分的健康结果部分是由于诊断较晚以及获得治疗和治疗方面的挑战造成的需要每天坚持的预防方式。这个问题在南非尤为严重这是世界上最严重的艾滋病毒流行病，三分之一的新感染病例发生在 AYA 人群中。最近的长效艾滋病毒预防和治疗配方的进步，无需每天服用药物重大承诺，特别是对 AYA 而言。 NICHD K08 HD094638 (2018-2023) 对 Neilan 博士的支持为以及来自艾滋病毒/艾滋病干预青少年医学试验网络 U24HD089880 (2017-2022)，我们制定了预防艾滋病并发症的成本效益——青少年和年轻人（CEPAC- AYA）微观模拟模型。我们进行了 12 项基于模型的临床和成本效益分析解决美国 AYA HIV 预防、诊断和治疗的关键问题。在一个新的美国—— 南非合作，我们现在建议调整和扩展这个模拟模型的结构，收集必要的数据输入，然后使用该模型来确定最有效和最具成本效益的南非 AYA 中艾滋病毒治疗和预防的方法和监测策略。我们有三个具体目标：目标 1. 在 CEPAC-AYA 模型中开发新结构并导出数据以允许建模南非 AYA 的长效 ART 和 PrEP 方案。目标 2. 评估新的以 AYA 为重点的治疗的临床影响、成本和成本效益旨在降低南非 AYA 机会性感染和死亡率的干预措施。目标 3. 评估新的以 AYA 为重点的预防的临床影响、成本和成本效益减少南非 AYA 中艾滋病毒感染率的干预措施。该提案的目标是评估针对具体情况、针对青少年的护理策略，并确定充分利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。和新的一样治疗和输送系统出现后，该模型将准备好告知如何最好地部署这些系统为这一弱势群体提供资源。