Evaluating the Link between HIV Prevention and Treatment

描述(由申请人提供)：在目前感染艾滋病毒的大约90万美国人中，多达28万人仍然不知道自己受到了感染，也无法获得可以防止病毒进一步传播的延长生命的服务。2002年，我们获得了开发艾滋病毒咨询、检测和转介(HIVCTR)以及艾滋病毒临床管理和经济学的计算机模拟模型的资金。在过去的两年里，我们实现了项目目标。在这份继续提案中，我们的目标是：1.完善我们的HIVCTR系统性能以及决策对患者生活质量和行为的影响的模拟模型。2.对扩大HIVCTR服务的价值和设计进行一系列政策评估。我们将：1.确定新批准的快速艾滋病毒检测方案比传统抗体检测更受青睐的情况；2.评估对主要艾滋病毒感染进行实时筛查的长期效益和成本；3.研究艾滋病毒检测结果如何转化为人群水平的疾病发病率变化，并探索减少传播对扩大HIVCTR的成本效益估计的可能影响；4.预测增加的病例识别和转诊对公共资助艾滋病毒服务需求的下游财务影响，包括医疗补助、瑞安·怀特护理法案和州艾滋病药物援助计划(ADAP)。在过去的10年里，我们的研究团队已经建立了出版和传播研究成果的记录，这些成果为国家在艾滋病毒患者护理、临床试验设计和实践指南制定方面的优先事项提供了信息。在这个项目的最初筹资周期中，我们已经证明了我们有潜力在艾滋病毒检测和预防政策领域产生同样深远的影响。

DESCRIPTION (provided by applicant): Of the roughly 900,000 Americans who are currently infected with HIV, as many as 280,000 remain unaware of their infection and without access to life-prolonging services that could prevent the further spread of the virus. In 2002, we were awarded funding to develop a computer simulation model of HIV counseling, testing, and referral (HIVCTR) and the clinical management and economics of HIV. Over the last 2 years, we have achieved our project objectives. Our aims, in this continuation proposal, are: 1. To refine our simulation model of HIVCTR system performance and the impact of decisions on patient quality of life and behavior. 2. To conduct a series of policy evaluations on the value and design of expanded HIVCTR services. We will: 1. Define the circumstances under which newly approved, rapid HIV testing protocols are preferred to traditional antibody tests; 2. Estimate the long-run benefits and costs of real-time screening for primary HIV infection; 3. Examine how HIV testing outcomes translate into population-level changes in disease incidence and explore the possible impact of reduced transmission on estimates of the cost-effectiveness of expanded HIVCTR; 4. Project the downstream financial impact of increased case identification and referral to care on the demand for publicly funded HIV services, including Medicaid, the Ryan White CARE Act, and state AIDS Drug Assistance Programs (ADAPS). Over the last 10 years, our research team has established a record of publishing and disseminating findings that inform national priority setting in HIV patient care, clinical trial design, and practice guideline development. During the initial funding cycle of this project, we have demonstrated our potential to exert an equally profound impact in the area of HIV testing and prevention policy.