Novel approaches to the design and evaluation of combination HIV prevention

描述（由申请人提供）：艾滋病毒预防工作，但没有单一的干预措施足以阻止美国的艾滋病毒流行。在缺乏“灵丹妙药”的情况下，面临的挑战是确定具体的一揽子方案和高价值目标，以便从每一笔预防资金中获得最大可能的好处。1994年，我们的研究小组发起了“预防艾滋病并发症的成本效益”（CEPAC）合作项目，开发一种计算机模拟艾滋病毒疾病的临床管理、结果和成本。我们使用CEPAC模型来评估HIV检测、治疗和预防方面最重要的发展的临床影响和成本效益。在这一应用中，我们建议使用CEPAC模型来提出三种思考艾滋病预防项目设计和评估的新方法：从政策捆绑的角度看待艾滋病预防；超越项目的成本效益，关注项目的可负担性；设计财政激励措施，转化为更好的长期艾滋病毒治疗结果。我们的具体目标是：1)制定一种分类法，描述预防项目相互捆绑时产生的协同效应和抵消效应。我们将利用CEPAC模型来探讨这些协同效应/抵消的大小如何随政策组合的规模和目标人群而变化。为了说明我们的方法的有效性，我们将评估早期抗逆转录病毒治疗和艾滋病毒暴露前预防联合使用时的成本效益。2)在进行成本效益分析的同时进行预算影响分析。我们将充分利用CEPAC模式的能力，在艾滋病毒筛查、治疗和预防服务的各个方面，为特定人群的特定支付者分配特定费用。为了说明我们的方法的有用性，我们将在选定的“热点”人群中评估高频艾滋病毒检测的成本效益和预算影响。3)制定一个框架，对财政激励措施的影响进行分类和衡量，以填补艾滋病毒护理连续体中的漏洞。我们将利用CEPAC模型的能力，将短期行为变化转化为下游的临床和流行病结果。为了说明我们的方法的有用性，我们将优化旨在实现国家艾滋病毒/艾滋病战略的治疗和预防目标的其他奖励包的设计。指导我们研究的广泛目标是促进对艾滋病毒资源分配的合理方法。我们的团队在传播影响国家艾滋病毒/艾滋病政策的研究结果方面有着良好的记录。目前的研究计划在以证据为基础的艾滋病毒预防计划设计和评估方面取得了进展。

DESCRIPTION (provided by applicant): HIV prevention works but no single intervention alone will be enough to stop the HIV epidemic in the United States. In the absence of a "magic bullet", the challenge is to identify specific program bundles and high-value targets that will squeeze the greatest possible benefit out of every prevention dollar. In 1994, our research group launched the "Cost-effectiveness of Preventing AIDS Complications" (or CEPAC) Collaboration, to develop a computer simulation of the clinical management, outcomes, and costs of HIV disease. We have employed the CEPAC Model to evaluate the clinical impact and cost-effectiveness of the most important developments in HIV detection, therapeutics, and prevention. In this application, we propose to use the CEPAC Model to advance three novel ways of thinking about HIV prevention program design and evaluation: viewing HIV prevention in terms of policy bundles; looking beyond program cost-effectiveness to program affordability; and designing financial incentives that translate into better long-term HIV outcomes. Our specific aims are: 1) To develop a taxonomy that characterizes the synergies and offsets that are created when prevention programs are bundled alongside one another. We will leverage the CEPAC Model to explore how the magnitude of these synergies/offsets varies with a policy bundle's scale and target population. To illustrate the usefulness of our approach, we will evaluate the cost-effectiveness of early antiretroviral therapy and HIV pre-exposure prophylaxis when used in combination with one another. 2) To conduct budget impact analysis alongside cost-effectiveness analysis. We will capitalize on the CEPAC Model's ability to assign specific costs to specific payers for specific populations, across the spectrum of HIV screening, treatment, and prevention services. To illustrate the usefulness of our approach, we will assess both the cost-effectiveness and budget impact of high-frequency HIV testing in select "hot spot" populations. 3) To develop a framework for categorizing and measuring the impact of financial incentives for plugging the leaks in the continuum of HIV care. We will exploit the CEPAC Model's capacity to translate/extrapolate short-run behavior change into downstream clinical and epidemic outcomes. To illustrate the usefulness of our approach, we will optimize the design of alternative incentive bundles aimed at achieving the treatment and prevention targets of the National HIV/AIDS Strategy. The broad objective that guides our research is to promote a reasoned approach to resource allocation in HIV. Our team has a proven record of disseminating findings that influence national HIV/AIDS policy. The current research plan advances the state of the art in evidence-based HIV prevention program design and evaluation.