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感染了艾滋病毒，也无法获得可以防止病毒进一步传播的延长生命服务。2002年，我们获得资助，开发艾滋病毒咨询、检测和转诊（HIVCTR）的计算机模拟模型，以及艾滋病毒的临床管理和经济学。在过去的两年里，我们已经实现了我们的项目目标。在这一延续建议中，我们的目标是：完善我们的HIVCTR系统性能和决策对患者生活质量和行为影响的模拟模型。2. 对扩大艾滋病毒/艾滋病防治服务的价值和设计进行一系列政策评估。我们将：1；确定在何种情况下新批准的快速艾滋病毒检测方案优于传统抗体检测；2. 估计实时筛查原发性艾滋病毒感染的长期效益和成本；3. 审查艾滋病毒检测结果如何转化为疾病发病率在人口水平上的变化，并探讨减少传播对扩大艾滋病毒感染率的成本效益估计可能产生的影响；4. 预计增加病例识别和转诊对公共资助的艾滋病毒服务需求的下游财务影响，包括医疗补助、Ryan White care法案和州艾滋病药物援助计划（ADAPS）。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结果的记录，这些发现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重点设定提供了信息。在这个项目最初的筹资周期中，我们已经证明我们有潜力在艾滋病毒检测和预防政策领域发挥同样深远的影响。

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.