HIV Prevention, Cost-Utility Analysis and Race/Ethnicity

描述（由申请人提供）：自1990年以来，美国的艾滋病发病率一直保持在每年约40，000例感染。然而，受艾滋病毒和艾滋病影响最严重的社区已经发生变化。从1981年到1987年，非洲裔美国人占艾滋病病例的25.5%，但在1996年到2000年期间占44.9%。在同一时期，拉丁裔社区的艾滋病病例从14.0%增加到19.7%，而白色、非西班牙裔艾滋病病例的比例从59.7%下降到34.0%。亚洲/太平洋岛民和美洲原住民/美洲印第安人/阿拉斯加原住民的艾滋病病例比例在两个时间段都保持在1%以下。尽管有这些明显的差异，艾滋病毒预防行为干预研究已经看到了在种族/少数民族社区的干预措施的发展滞后。此外，在关于艾滋病毒预防干预措施的成本效益的全部文献中，只有两项经济评价研究是专门针对少数种族/族裔社区的干预措施进行的。分配艾滋病毒预防服务资金的决策者必须了解各种艾滋病毒预防干预措施的成本和后果，以便就如何利用现有资源作出明智的决定，从而最大限度地减少各社区的艾滋病毒感染人数。虽然这两项研究都遵循了进行成本效益分析的一般方法建议，但这些建议并不专门针对涉及种族/少数民族社区的研究。因此，在艾滋病毒预防领域需要注意更多的方法工作和更多地应用这些方法，重点是受艾滋病毒/艾滋病流行病影响特别严重的少数种族/族裔社区。我们建议在这个为期一年的项目中处理其中一些问题。拟议项目的具体目标如下：应用最先进的成本效用分析方法（回顾性），以两个单独的艾滋病毒预防行为干预非洲裔美国人-一个侧重于男同性恋和双性恋男子，一个侧重于妇女的艾滋病毒血清状态不明-以衡量这些预防服务的成本效益。在这两项独立的应用研究中，我们将使用最先进的方法将艾滋病预防行为干预分为节省成本、成本效益高或成本效率低。我们假设，每一种行为干预措施相对于该干预措施的比较条件而言都是节省成本的。我们还将使用广泛的敏感性分析，以确定可能受种族/民族相关文化和/或社会因素影响的参数可能影响成本效用分析结果的程度，并全面报告这些敏感性分析。我们建议在科学期刊上发表研究结果，并以严谨而简洁的方式为艾滋病毒预防优先事项的制定者总结研究结果。

DESCRIPTION (provided by applicant): Since 1990, HIV incidence in the U.S. has been approximately constant at 40,000 infections per year. However, the communities most heavily impacted by HIV and AIDS have changed. African-American persons comprised 25.5% of AIDS cases from 1981 to 1987, but 44.9% during 1996 to 2000. Latino communities increased from 14.0% to 19.7% of AIDS cases during the same time frames, and White, non-Hispanic persons fraction of AIDS cases dropped from 59.7% to 34.0% during those time periods. Asian/Pacific Islander and Native American/American Indian/Alaskan Native proportions of AIDS cases stayed under 1% in both time frames. Despite these clear disparities, HIV prevention behavioral intervention research has seen a lag in the development of interventions for racial/ethnic minority communities. Further, in the entire literature on the cost-effectiveness of HIV prevention interventions, only two economic evaluation studies have been conducted on interventions designed specifically for racial/ethnic minority communities. Policymakers who allocate HIV prevention service funds must know about the costs and consequences of various types of HIV prevention interventions in order to make sound decisions about how to use available resources so as to maximize the number of HIV infections in various communities. Although both of these studies followed general methodological recommendations for conducting cost-effectiveness analyses, these recommendations are not focused specifically for studies involving racial/ethnic minority communities. Therefore, more methodological work and more applications of such methods needs attention in the field of HIV prevention as focused on racial/ethnic minority communities disproportionately impacted by the HIV/AIDS epidemic. We propose to attend to some of these issues in this one-year project. The specific aims of the proposed project are as follows: To apply state-of-the-art cost-utility analysis methods (retrospectively) to two separate HIV prevention behavioral interventions for African American persons - one focused on gay and bisexual men, and one focused on women of undetermined HIV serostatus - so as to gauge the cost-effectiveness of these prevention services. In each of the two separate application studies, we will use the state-of-the-art methods to classify the HIV prevention behavioral intervention as either cost saving, cost-effective or cost inefficient. We hypothesize that each behavioral intervention will be cost saving relative to the comparison condition for that intervention. We will also use extensive sensitivity analyses to determine the extent to which parameters that may be influenced by cultural and/or societal factors related to race/ethnicity might influence the cost-utility analytic results and report fully on these sensitivity analyses. We propose to publish the findings in scientific journals and summarize the findings in a rigorous yet succinct manner for HIV prevention priority setters.