Evaluating the Impact of Integrated and Differentiated HIV-NCD Service Delivery through Mathematical Modeling - PROJECT SUMMARY Background. Hypertension and diabetes are among the most common risk factors for cardiovascular disease among people living with HIV (PLHIV), with prevalence up to 54% in high-income countries, and 46% in lowand middle-income countries. Yet, most people with these comorbidities are undiagnosed or undertreated. In Zambia, only 14% of 750,098 adults living with HIV received blood pressure screening in 2021. Of those, 15% had hypertension, and only 9% received antihypertensive medication. Diabetes screening reached only 8-13% of PLHIV. While many countries recommend integrating non-communicable disease (NCD) screening into HIV care with various self-testing kits to address these shortfalls, there is an increasing number of patients who need both anti-retroviral treatment (ART) and NCD management; Integrating care may overwhelm the health system, especially in high-burden, densely populated areas. To date, however, no study has determined if integrating HIV-NCD screening and care influences overall clinic visits, key health outcomes, and program cost effectiveness. Using the Center for Infectious Disease Research in Zambia (CIDRZ)fs large NIH-funded trial dataset (TASKPEN, NCT05950919) and mathematical modeling, we aim to evaluate the epidemiological impact and cost-effectiveness of integrating NCD screening and treatment at scale for PLHIV in Zambia.one of the earliest adopters of integrated HIV-NCD service delivery.versus the current standard of care. Candidate Overview. My long-term goal is to become an independent investigator specializing in the design and evaluation of integrated service delivery for multimorbidity management. Drawing on my background in health systems research, economic evaluation, and disease modeling, I have developed a training plan with mentorship in HIV and NCD epidemiology, health system dynamics, and model calibration and validation. Research Strategy. My study will 1) determine the effect of an integrated HIV-NCD care model on clinical outcomes among PLHIV with .1 cardiometabolic NCD; 2) estimate the long-term health impact and costs of service integration and multi-month drug dispensing strategies using mathematical modeling; and 3) determine the cost-effectiveness of service integration and multi-month drug dispensing strategies under different health systems' capacities and community disease prevalence conditions. Relevance to U.S. public health. CIDRZ provides access to one of the worldfs most mature HIV treatment programs with a rapidly aging patient population experiencing high burdens of cardiometabolic comorbidities. This setting offers a unique, accelerated opportunity to study multimorbidity patterns, care delivery challenges, and outcomes of integrated service models directly relevant to the growing population of older adults living with HIV in the United States. With 54% of U.S. people living with HIV now aged 50 years or older, and an estimated 60.80% experiencing multimorbidity, this work will inform integrated care models for Ryan White clinics and other safety-net systems, where improving chronic disease care coordination is a national priority.
