Evaluating the Link between HIV Prevention and Treatment

描述(申请人提供)：在目前感染艾滋病毒的大约100万美国人中，多达30万人仍然不知道自己受到了感染，也无法获得可防止进一步传播的延长生命的护理。在2002年和2005年，我们获得了开发基于计算机的艾滋病毒疾病检测、临床管理和经济学评估模型的资金。我们的发现对美国的艾滋病毒筛查政策和指南的制定产生了深远的影响。我们继续竞争的目标是：1.改进模拟模型，以更准确地描述艾滋病毒感染的检测和风险、早期艾滋病毒疾病的自然历史以及筛查对艾滋病毒二次传播的影响。2.就疾控中心2006年修订的扩大艾滋病毒筛查建议提出的问题进行一系列政策评估。我们将：“评估美国疾病控制与预防中心提出的艾滋病毒检测和确认算法；评估常规艾滋病毒筛查策略与目标策略的成本效益；评估美国艾滋病毒检测、关联和保留不足的生存成本；预测增加的病例识别和转诊对美国公共资助艾滋病毒服务需求的预算影响(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)。这一建议的动机是最近的几份报告，这些报告认为，艾滋病毒筛查不足是美国遏制艾滋病毒流行努力的一个关键失败。这项研究计划将推动以证据为基础、模型驱动的政策分析的最先进水平。 与公共卫生相关：在目前感染艾滋病毒的大约100万美国人中，约有30万人仍然不知道自己感染了艾滋病毒，也无法获得可防止进一步传播的延长生命的护理。该项目使用数学模拟模型来收集和分析可用的最佳临床和成本数据，为当前的政策辩论提供信息，并在美国推广基于证据的艾滋病毒咨询、检测和转诊方法。

DESCRIPTION (provided by applicant): Of the estimated 1 million Americans who are currently infected with HIV, as many as 300,000 remain unaware of their infection and without access to life-prolonging care that could prevent further transmission. In 2002 and 2005, we were awarded funding to develop a computer-based evaluation model of the detection, clinical management, and economics of HIV disease. Our findings have had a profound impact on HIV screening policy and guideline development in the United States. Our aims for this competing continuation are: 1. To refine the simulation model to more accurately portray the detection and risk of HIV infection, the natural history of early HIV disease, and the impact of screening on secondary HIV transmission. 2. To conduct a series of policy evaluations on questions arising from the CDC's 2006 revised recommendations for expanded HIV screening. We will: " evaluate the CDC's proposed algorithms for HIV detection and confirmation in the US; " assess the cost-effectiveness of routine versus targeted strategies for HIV screening; " estimate the survival costs of inadequate HIV detection, linkage, and retention in the US; " forecast the budgetary impact of increased case identification and referral to care on the demand for publicly funded HIV services in the US (including Medicaid, the Ryan White CARE Act, and state AIDS Drug Assistance Programs). This proposal is motivated by several recent reports that identify inadequate HIV screening as a critical failing in the effort to contain the HIV epidemic in the US. This research plan will advance the state of the art in evidence-based, model-driven policy analysis. PUBLIC HEALTH RELEVANCE: Of the estimated 1 million Americans who are currently infected with HIV, roughly 300,000 remain unaware of their infection and without access to life-prolonging care that could prevent further transmission. This project uses a mathematical simulation model to assemble and analyze the best available clinical and cost data, to inform current policy debates, and to promote an evidence-based approach to HIV counseling, testing, and referral in the United States.