Cost-Effectiveness of Preventing Acute-Phase HIV Transmission

描述（由申请人提供）：需要新的干预策略将美国的HIV感染率降低到目前的40K平台以下。初始感染的高传染性急性期代表了一个有希望但相对未开发的行为改变干预目标。识别急性感染者并帮助他们减少将病毒传播给他人的风险的干预措施可以在将艾滋病毒发病率降低到40K平台以下的努力中发挥重要作用。然而，这些干预措施的最终影响取决于感染急性期传播的实际程度，以及减少急性期艾滋病毒传播的潜在干预措施的成本效益。为了加强目前对急性期艾滋病毒传播的流行病学影响的了解，以及在这一传染性升高时期减少艾滋病毒传播的潜在战略的成本效益，我们将：1)建立数学模型和程序，以估计每年因急性期传播引起的艾滋病毒感染事件数量，1998年至2004年这类感染的总数，以及减少急性期艾滋病毒传播的干预措施的潜在流行病学和经济影响。2)评估在现有艾滋病毒咨询和检测服务的基础上，对汇集的检测样本进行艾滋病毒rna检测的效率和成本效益，以促进对急性感染者的识别，并鼓励减少行为风险，预防急性期艾滋病毒传播。3)评估成本并估计综合暴露后预防方案避免的HIV感染数量，该方案将抗逆转录病毒预防与2期行为风险降低干预或更强化的5期干预相结合。该项目将提供急性期艾滋病毒传播的规模和后果的估计，以及在感染急性期预防传播的各种干预策略的潜在经济效率。联邦、州和地方各级决策者需要这些信息，他们必须优先考虑艾滋病毒预防干预措施的制定和实施。研究结果将为关于减少急性期传播的干预措施的重要性的科学和政策讨论提供信息。

DESCRIPTION (provided by applicant): Novel intervention strategies are needed to reduce HIV incidence in the US below the current 40K plateau. The highly-infectious acute phase of initial infection represents a promising but relatively unexplored target for behavioral change interventions. Interventions that identify acutely-infected persons and help them reduce their risk of transmitting the virus to others could play an important role in efforts to reduce HIV incidence below the 40K plateau. However, the ultimate impact of these interventions depends on the actual extent of transmission during the acute phase of infection, as well as on the cost-effectiveness of potential interventions to reduce acute-phase HIV transmission. To enhance current understanding of the epidemiological impact of acute-phase HIV transmission and the cost-effectiveness of potential strategies to reduce HIV transmission during this period of elevated infectiousness, we will: 1) Develop mathematical models and procedures to estimate the annual number of incident HIV infections due to acute-phase transmission, the total number of such infections from 1998 through 2004, and the potential epidemiological and economic impact of interventions to reduce acute-phase HIV transmission. 2) Assess the efficiency and cost-effectiveness of supplementing existing HIV counseling and testing services with HIV-RNA testing of pooled test samples to facilitate identification of acutely-infected persons and encourage behavioral risk reduction to prevent acute-phase HIV transmission. 3) Assess the costs and estimate the number of HIV infections averted by a comprehensive post-exposure prophylaxis program that combined antiretroviral prophylaxis with either a 2-session behavioral risk reduction intervention or a more intensive 5-session intervention. This project will provide estimates of the magnitude and consequences of acute-phase HIV transmission, and the potential economic efficiency of various intervention strategies to prevent transmission during the acute phase of infection. This information is needed by decision makers at federal, state, and local levels who must prioritize HIV prevention intervention development and implementation. The results will inform scientific and policy discussions on the importance of interventions to reduce acute-phase transmission.