UTILIZATION AND COST EFFECTIVENESS OF NEW HIV TESTS

目标1是检查与人们决定在哪里进行检测相关的因素，特别是他们是选择在家里、医生办公室还是公共诊所进行检测。经过10年的争论，美国食品和药物管理局于1996年批准了第一次家庭收集艾滋病毒检测。之前的调查发现，很大一部分美国人可能会使用家庭收集测试，包括那些没有接受测试和高风险的人。我们现在有了一个独特的机会，可以利用全国代表性调查和其他来源的数据，检查谁在实际使用家庭收集测试，以及用户的特征与在其他地方接受测试的个人相比如何。我们还将收集新数据，分析个人对不同检测地点和方法的偏好，研究接受检测的人数和地点随时间推移的趋势，并将家庭收集检测的实际使用率与表示在可用之前会使用这些检测的人数进行比较。目标2是检查一系列测试地点和方法的成本效益，包括家庭收集测试。家庭收集艾滋病毒检测的批准为新的检测技术打开了大门，这些技术有望极大地改变艾滋病毒检测的性质，包括快速检测、口腔液体检测、尿液检测和自我检测（“真正的”即时结果的家庭检测）。新的艾滋病毒检测可能会通过改变个人接受检测的意愿、发现艾滋病毒阳性的人数和检测的成本来改变检测项目和政策的成本效益。因此，我们将对测试替代方案进行成本效益分析，并纳入从拟议研究的第一个目标中获得的独特数据。我们将研究研究结果对政策的影响，包括新的检测方法如何有助于早期发现艾滋病毒感染者并使他们得到护理；新测试带来的成本和收益转移对个人、提供者和决策者的影响；新的测试技术将带来经济、社会和伦理问题。

Aim #1 is to examine the factors associated with people's decisions on where to be tested, particularly whether they choose to be tested at home, doctors' offices, or public clinics. After 10 years of debate, the FDA approved the first home collection HIV test in 1996. Previous surveys found that a large percentage of the U.S. population could be likely to use home collection tests, including those who had not been tested and who were at high risk. We now have the unique opportunity to examine who is actually using home collection tests and how users' characteristics compare to individuals tested elsewhere, using data from nationally representative surveys and other sources. We will also collect new data and analyze existing data on individuals' preferences for different testing sites and methods, examine trends over time in how many people are tested and where they are tested, and compare te actual rates of use of home collection tests to how many people stated that they would use these tests before they were available. Aim # 2 is to examine the cost-effectiveness of a range of testing sites and methods, including home collection tests. The approval of home collection HIV tests opens the door to new testing technologies that promise to dramatically change the nature of HIV testing, including rapid tests, oral fluids tests, urine tests, and self- testing ("true" home tests with instant results). New HIV tests may change the cost effectiveness of testing programs and policies by changing the willingness of individuals to be tested, the number of persons found to be HIV- positive, and the cost of testing. We will therefore conduct a cost-effectiveness analysis of testing alternatives which incorporates the unique data obtained from the first aim of the proposed study. We will examine the policy implications of our findings, including how new testing methods can facilitate the early identification of HIV -infected persons and their entry into care; the implications for individuals, providers, and policymakers of the shifting of costs and benefits as a result of new tests; and the economic, social, and ethical issues that will arise because of new testing technologies.