Simulation Modeling of Hepatitis B Virus Elimination Strategies in Cote d'Ivoire

Project Summary Hepatitis B virus (HBV) is the world's leading cause of cirrhosis, liver cancer, and liver-related mortality. Its burden is increasing around the world, especially in sub-Saharan Africa. Even though millions of people across sub-Saharan Africa are known to have chronic hepatitis B infection, very few eligible patients are started on treatment. The complexity and cost of laboratory monitoring, liver fibrosis assessments, and antiviral treatment are some of the major challenges preventing scale-up of treatment. My goal is to determine whether hepatitis B management guidelines can be simplified so that limited healthcare resources are focused on expanding hepatitis B treatment in resource-limited settings. Simulation models are evidence-based tools that are increasingly being used by investigators to address complex questions such as this, by assessing the long-term clinical impact of existing as well as novel hepatitis B treatment initiation strategies. I am an Infectious Diseases physician with a research background in clinical epidemiology, simulation modeling, and cost-effectiveness analysis. I am motivated to expand on my current skillset and gain training to apply these methodologies to investigate HBV treatment strategies in sub-Saharan Africa. The Mentored Research Scientist Development Award will afford me the opportunity to gain the necessary skills to become an independent clinical investigator. I require specific training in (1) model design and validation; (2) derivation of clinical and economic outcome data; and (3) designing and executing cost-effectiveness analyses. I have designed a didactic curriculum to address each of these training aims. I have also assembled a multi-disciplinary team of mentors and collaborators with methodological and/ or content expertise who are devoted to my success in achieving the aims of this proposal. By the end of the award period, I will have designed and validated a novel HBV simulation model, populated the model with clinical and economic data from sub-Saharan Africa, and used the model conduct a high impact cost-effectiveness analysis that has the potential to guide HBV management across the continent.