Evaluating the Link between HIV Prevention and Treatment

描述(由申请人提供)：估计800,000至900,000人 目前感染艾滋病毒的美国人，据信多达 275,000人仍然不知道自己受到了感染，因此无法接触到 延年益寿的护理或咨询，可以防止疾病的进一步传播 病毒。这一发人深省的事实表明，是时候重新考虑公众了。 艾滋病毒咨询、检测和转介的健康方法(艾滋病毒CTR) 并量化未能提供足够资金的后果 筛查、治疗和预防。在过去的七年里，我们的研究 该组织使用计算机发布了18项同行评议的政策评估 HIV临床管理和经济学的模拟模型。我们的发现 对美国艾滋病毒患者的护理决策产生了直接影响。我们 现在建议扩展我们的模型，以解决设计和 在艾滋病毒CTR中设定优先事项。我们有两个具体目标：(1)我们将把我们的 将现有的疾病模拟扩展到一种新的“筛查/摄取”模型 广泛的高危目标人群、临床环境和 测试/咨询方案。我们将对以下几个步骤进行编纂 通过治疗和咨询检测艾滋病毒，以应对病毒的变化 传染性、危险行为和疾病传播。我们将组装 最新的临床、流行病学、经济和行为数据 一个单一的综合框架。这将创造第一个全面的， 基于模型的工具，用于评估艾滋病毒咨询、检测和转介。 (2)我们将进行和传播三项政策评估，评估 扩大艾滋病毒CTR服务的影响。A)我们将评估临床和 与疾病预防控制中心最近公布的草案相一致的经济影响 修订的艾滋病毒咨询、检测和转诊指南。B)我们会 对替代CTR干预设计进行广泛评估，并 为希望定制计划的决策者提供实用指导 归因于人口和环境的特定需求。C)我们将执行 首次正式探讨艾滋病毒扩大传播的益处和风险 HAART时代的CTR。调查人员有可靠的生产和销售记录 传播有助于确定艾滋病毒患者护理优先事项的调查结果， 临床试验设计和指南的制定。我们的目标，在当下 提议，是对艾滋病毒优先事项的确定产生同样深远的影响 检测和预防。

DESCRIPTION (provided by applicant): Of the estimated 800,000 to 900,000 Americans who are currently infected with HIV, it is believed that as many as 275,000 remain unaware of their infection and are therefore without access to life-prolonging care or counseling that could prevent the further spread of the virus. This sobering fact suggests that it is time to reconsider the public health approach to HIV counseling, testing, and referral (HIV CTR) in the United States and to quantify the consequences of failing to provide adequate screening, treatment, and prevention. In the last seven years, our research group has published eighteen peer-reviewed policy evaluations using a computer simulation model of the clinical management and economics of HIV. Our findings have had a direct impact on HIV patient care decisions in the United States. We now propose to expand our model in order to address questions of design and priority setting in HIV CTR. We have two specific aims: (1) we will link our existing disease simulation to a new "screening/intake" model that can portray a broad spectrum of at-risk target populations, clinical settings, and testing/counseling protocols. We will codify the various steps that lead from detection of HIV, through treatment and counseling, to changes in viral infectivity, risky behavior, and disease transmission. We will assemble the most up-to-date clinical, epidemiological, economic, and behavioral data within a single, integrated framework. This will create the first comprehensive, model-based tool for the evaluation of HIV counseling, testing, and referral. (2) We will conduct and disseminate three policy evaluations assessing the impact of expanded HIV CTR services. a) We will evaluate the clinical and economic effects of conformity with the CDC's recently promulgated draft Revised Guidelines for HIV Counseling, Testing, and Referral. b) We will conduct an extensive assessment of alternative CTR intervention designs and provide practical guidance to decision makers wishing to tailor program attributes to population-, and setting-specific needs. c) We will perform the first formal exploration of the transmission benefits and risks of expanded HIV CTR in the HAART era. The investigators have a proven record of producing and disseminating findings that have helped to set priorities in HIV patient care, clinical trial design, and guideline development. Our aim, in the present proposal, is to exert an equally profound impact on priority setting in HIV testing and prevention.