# Optimizing HIV Care in Less Developed Countries

> **NIH NIH R37** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $594,123

## Abstract

Project Summary/Abstract
Despite major advances in treatment and prevention of HIV infection, the HIV/AIDS pandemic continues to
cause tremendous morbidity and mortality. Of the 36.7 million people living with HIV worldwide, only 57%
are receiving antiretroviral therapy. One million people died from AIDS-related illness in 2016, and nearly
two million are newly infected with HIV each year. The HIV burden is highest in parts of the world that face
the additional challenge of constrained resources. HIV testing and treatment guidelines have continually
evolved, capturing the benefits associated with improved testing, more effective antiretroviral therapy and
lab monitoring, and increasingly effective prevention interventions. It is clear that the pandemic could be
better controlled using existing tools. What remains unclear, however, is what specific strategies and overall
approach would be most effective for specific populations, given the important reality of budget constraints.
This competing continuation proposes to expand upon the Cost-Effectiveness of Preventing AIDS
Complications International (CEPAC-I) Model, a computer microsimulation of the natural history, clinical
management, outcomes, costs, and cost-effectiveness of HIV treatment. It will identify the testing,
treatment, and prevention interventions that provide the most value in terms of decreasing HIV incidence
and improving life expectancy with HIV. The CEPAC-I team, made up of a collaboration of leading HIV
investigators, is based in the United States, with key collaborators in South Africa, Côte d'lvoire, India, and
Brazil. This team will address critical questions around the cost-effectiveness of new interventions for HIV in
high-risk populations. The results will inform clinicians, policymakers, and people living with HIV in multiple
resource-limited settings. In addition, this proposal includes development of innovative modeling
optimization methods to identify the combinations of testing, treatment, and prevention strategies that will
have the greatest impact on specific populations in different countries.
This proposal has two specific aims:
Specific Aim 1: To expand the CEPAC-I microsimulation to address clinical policy questions, focused
on key populations, using data from recent clinical trials and implementation research studies.
Specific Aim 2: To develop a novel optimization model to determine the combination of HIV care
interventions that maximizes survival, or minimizes HIV incidence, in countries with different epidemic
characteristics and different resource constraints.
In close alignment with the 2018 research priorities of the NIH Office of AIDS Research, the goals of this
proposal include reducing the incidence of HIV, investigating next-generation therapies, identifying optimal
prevention and treatment responses, and reducing health disparities by improving outcomes in key
populations.

## Key facts

- **NIH application ID:** 9984284
- **Project number:** 5R37AI058736-16
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Kenneth Alan Freedberg
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $594,123
- **Award type:** 5
- **Project period:** 2004-07-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9984284

## Citation

> US National Institutes of Health, RePORTER application 9984284, Optimizing HIV Care in Less Developed Countries (5R37AI058736-16). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9984284. Licensed CC0.

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