The past several years have seen major progress in the delivery of treatment and care to HIV-infected people in the developing world. However, substantial uncertainty persists regarding optimal treatment strategies, the cost of second- and third-line antiretroviral treatment, and the impact of expanded care. As the HIV epidemic continues to grow, these problems require critical analysis. In 2004, NIAID awarded our research group funding to develop the """"""""Cost-effectiveness of Preventing AlDS Complications (CEPAC) International"""""""" Model, a computer simulation of the natural history, clinical management, outcomes, and costs of HIV disease in South Africa, Cote d'lvoire, and India. The current project has produced 16 publications, including a widely cited New England Journal of Medicine article, and another 9 submitted or draft manuscripts in its first 3 years. In this competing continuation, we request support to develop a 2nd generation CEPAC-International Model. This new model will reflect the most current understanding of HIV and AlDS epidemiology, treatment efficacy, impact on TB transmission and cost-effectiveness of care. The three specific aims of the current proposal are: 1) To refine the CEPAC-International Model's portrayal of critical patient- and population-level effects. This will include multiple entry cohorts staggered in time, person-to-person HIV transmission and TB transmission, long-term ART-related toxicities and co-morbidities, and to refine the approach to antiretroviral drug resistance. 2) To project clinical outcomes, cost, and cost-effectiveness of different patient-level treatment strategies for HIV care in developing countries;and 3) To identify optimal population-level HIV and AIDS treatment and prevention strategies in developing countries. The assembled research team has an extensive record of publishing and disseminating findings that inform priority setting in HIV care and practice guideline development, in the US and internationally. To augment the team's modeling capacity, skilled investigators with experience in HIV/TB co-infection, transmission dynamics as well as infectious disease modeling have been added to the team. By continuing the major progress already made by this multidisciplinary team, and accomplishing the specific aims described above, the proposed studies will address the most crucial HIV clinical policy and cost-effectiveness questions that will face providers and policy-makers in developing countries over the next several years.

Public Health Relevance

Despite recent progress globally to deliver HIV treatment and care to developing countries, major challenges remain in fully implementing these programs and understanding the clinical outcomes and cost-effectiveness of different strategies for HIV care worldwide. The CEPAC-International Model provides an inexpensive yet broadly applicable way of studying HIV interventions, projecting their outcomes, and highlighting important areas for future research. The flexibility of our program allows our team to investigate problems from several angles, providing insight into scenarios that may not be feasible to test in real-life settings through large-scale clinical trials.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-G (03))
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Huebner, Robin E
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Massachusetts General Hospital
United States
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Paltiel, A David; Zheng, Amy; Weinstein, Milton C et al. (2017) Setting Performance Standards for a Cost-Effective Human Immunodeficiency Virus Cure Strategy in South Africa. Open Forum Infect Dis 4:ofx081
Hyle, Emily P; Jani, Ilesh V; Rosettie, Katherine L et al. (2017) The value of point-of-care CD4+ and laboratory viral load in tailoring antiretroviral therapy monitoring strategies to resource limitations. AIDS 31:2135-2145
Ahonkhai, Aima A; Onwuatuelo, Ifeyinwa; Regan, Susan et al. (2017) The patient-centered medical home: a reality for HIV care in Nigeria. Int J Qual Health Care 29:654-661
Walensky, Rochelle P; Borre, Ethan D; Bekker, Linda-Gail et al. (2017) Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid. Ann Intern Med 167:618-629
Hyle, Emily P; Mayosi, Bongani M; Middelkoop, Keren et al. (2017) The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review. BMC Public Health 17:954
Hyle, Emily P; Jani, Ilesh V; Rosettie, Katherine L et al. (2017) The value of point-of-Care CD4 and Laboratory viral Load in tailoring ART monitoring Strategies to resource limitations. AIDS :
Ahonkhai, Aimalohi A; Adeola, Juliet; Banigbe, Bolanle et al. (2017) Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort. J Int Assoc Provid AIDS Care 16:98-104
Hermans, Sabine; Caldwell, Judy; Kaplan, Richard et al. (2017) The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa. Bull World Health Organ 95:554-563
Dunning, Lorna; Francke, Jordan A; Mallampati, Divya et al. (2017) The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: A cost-effectiveness analysis. PLoS Med 14:e1002446
O'Laughlin, K N; Kasozi, J; Rabideau, D J et al. (2017) The cascade of HIV care among refugees and nationals in Nakivale Refugee Settlement in Uganda. HIV Med 18:513-518

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