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.

项目概要/摘要 在美国，注射吸毒者 (PWID) 占丙型肝炎病毒 (HCV) 感染的大部分。 改善 HCV 护理连续性，特别是关注 HIV 合并感染的并发症至关重要 以实现消除 HCV。吸毒者之间的异质注射和性网络可以显着 影响丙型肝炎病毒和艾滋病毒的传播和干预结果。尽管实证研究表明， 在直接作用抗病毒 (DAA) 时代，改善 HCV 护理连续性的干预措施已经开始 积累，但仍然缺乏对人口水平影响和成本效益的了解 这些干预措施为决策提供信息。我的长期目标是发展数学和统计 模拟模型为与传染病控制相关的卫生政策提供信息。总体目标为 这个应用程序是实现我的长期目标的关键一步，它是开发一个动态代理- 基于丙型肝炎病毒和艾滋病毒在吸毒者中传播的网络模型，以确定人口层面的影响 以及改善丙肝护理连续性的干预措施的成本效益。我的中心假设是 针对护理连续体的多个阶段的干预措施，考虑到个人特征， 服务环境以及中观/宏观层面的背景将对人口层面产生重大影响 减少 HCV 和 HIV 感染及相关并发症，同时具有成本效益。中央 将通过追求三个具体目标来检验假设： 1) 确定 HCV 护理的社会决定因素 注射吸毒者的连续结果，以及在 DAA 时代改善这些结果的有效干预措施； 2) 确定不同干预措施对人口层面的影响和成本效益，以改善 注射吸毒者的丙肝护理连续性； 3) 确定人口层面影响差异的决定因素 根据吸毒者网络的具体特征，采取干预措施改善丙肝护理连续性。我会 通过系统评价和荟萃分析（目标 1）来实现这些目标，扩展我们的 HCV 模型 通过注射网络传播，将性网络和艾滋病毒传播纳入其中（目标 2），并进行拟合 将模型应用于不同的注射吸毒者网络并评估整个网络的影响（目标 3）。要完成 研究并推进我的职业生涯，我将获得证据综合、贝叶斯方法的研究培训 用于模型校准、健康经济学以及科学传播方面的专业培训， 在卫生政策司的跨学科环境中的领导和协作 斯坦福大学医学院。预期结果是一个新的模型平台来评估复杂的 改善吸毒者健康的 HIV/HCV 干预策略。拟议的研究意义重大 因为研究结果将系统地了解吸毒者和吸毒者丙型肝炎护理的社会决定因素 关于改善人口水平的干预措施的人口层面影响和成本效益的重要证据 不同吸毒者人群的丙肝护理连续性，为丙肝消除政策制定提供信息。