UTILIZATION AND COST EFFECTIVENESS OF NEW HIV TESTS

第一个目标是检查与人们决定在哪里进行检测有关的因素，特别是他们是否选择在家里、医生办公室或公共诊所进行检测。经过10年的争论，FDA于1996年批准了第一个家庭收藏品艾滋病毒检测。之前的调查发现，很大比例的美国人口可能会使用房屋收集测试，包括那些没有接受测试的人和高危人群。我们现在有一个独特的机会来检查谁实际上正在使用家庭收集测试，以及用户的特征与其他地方测试的个人相比如何，使用来自全国代表性调查和其他来源的数据。我们还将收集新的数据并分析个人对不同测试地点和方法的偏好的现有数据，检查随着时间的推移有多少人接受测试以及在哪里进行测试的趋势，并将家庭收集测试的实际使用率与表示他们将在这些测试之前使用这些测试的人数进行比较。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(具有即时结果的“真正”家庭检测)。新的艾滋病毒检测可能会通过改变接受检测的个人意愿、被发现为艾滋病毒阳性的人数和检测成本来改变检测计划和政策的成本效益。因此，我们将对测试替代品进行成本效益分析，其中纳入了从拟议研究的第一个目标获得的独特数据。我们将研究我们发现的政策影响，包括新的检测方法如何促进艾滋病毒感染者的早期识别和他们进入护理；新检测结果的成本和收益转移对个人、提供者和政策制定者的影响；以及新检测技术将产生的经济、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.