Global Health Comparative Effectiveness: A Data Synthesis Method Applied to HIV

Investigator: James Kahn, MD, MPH
Sponsor: NIH National Institute of Allergy and Infectious Disease

Location(s): United States


For HIV and other globally important health conditions, there are hundreds of studies and dozens of reviews assessing the effects of prevention and treatment interventions, with data that is highly technical and presented in inconsistent formats. In addition, data on efficacy (i.e., from the optimal conditions of clinical trials) is often not distinguished from data on effectiveness (i.e., from real-world circumstances). These limitations reduce the value of intervention assessment studies for the development of policies and programs. The goal of this study is to develop and implement innovative approaches to translate existing data on the health benefits of HIV prevention and treatment interventions into an accurate and transparent empirical basis for global health HIV policies and programs, thus increasing the value and use of empirical studies for real-world implementation. The specific aims are to: (1) assess evidence regarding the efficacy and effectiveness of prevention and treatment interventions for HIV, including the development of an effectiveness score that describes how well studies reflect real-world implementation, and an assessment of how the magnitude of intervention benefit varies with this score; (2) by combining data on effectiveness and disease burden, translate the effect of specified interventions implemented at large scale to estimate reduced population-level disease burden; (3) incorporating effectiveness, burden reduction, and cost, calculate the cost-effectiveness of sets of interventions; and, (4) make findings in Aims 1 to 3 easily accessible to decision-makers and other technical and non-technical end users through a web-based resource. The impact of this work is potentially large. HIV is expected to account for 128 million disability-adjusted life years (DALYs) per year in 2015, the largest burden in the developing world. Thus, small gains in programming efficiency as a result of our syntheses and analyses could have large health benefits. In addition, our methods can be applied to other global health conditions. There are thousands of studies measuring the effects of HIV prevention and treatment interventions, yielding data that are highly technical, presented in inconsistent formats, and usually inaccessible to policy-makers. This project will use innovative and rigorous methods to develop clear and accurate data on effectiveness, potential reduction in HIV disease burden, and costs for combinations of HIV interventions. The analysis will provide valuable information and tools to inform global HIV policies and programs.