Evaluating the Link between HIV Prevention and Treatment

描述（由申请人提供）：估计800，000至900，000 目前感染艾滋病毒的美国人，据信多达 275，000人仍然不知道他们的感染，因此无法获得 延长生命的护理或咨询，可以防止进一步传播的 病毒这一发人深省的事实表明，现在是时候重新考虑公众 艾滋病毒咨询、检测和转诊的健康方法（艾滋病毒CTR） 并量化未能提供充分的 筛查、治疗和预防。在过去的七年里，我们的研究 一个小组已经用计算机发布了18份同行评议的政策评估报告 艾滋病毒临床管理和经济学的模拟模型。我们的研究结果 对美国艾滋病患者的护理决策产生了直接影响。我们 现在建议扩展我们的模型，以解决设计问题， 在艾滋病毒合作减少威胁方面确定优先事项。我们有两个具体目标：（1）我们将把我们的 现有的疾病模拟到一个新的“筛选/摄入”模型， 广泛的高危目标人群、临床环境，以及 测试/咨询协议。我们将编纂各种步骤，导致从 艾滋病毒检测，通过治疗和咨询， 传染性、危险行为和疾病传播。我们将集合 最新的临床，流行病学，经济和行为数据， 一个单一的综合框架。这将创造第一个全面的， 基于模型的工具，用于评估艾滋病毒咨询、检测和转诊。 (2)我们将进行和传播三项政策评估， 扩大艾滋病毒合作减少风险服务的影响。a）我们将评估临床和 符合疾病预防控制中心最近颁布的草案的经济影响 艾滋病毒咨询、检测和转诊指南修订版。B）我们会 对替代CTR干预设计进行广泛评估， 为希望调整方案的决策者提供实际指导 人口和环境的具体需要。（三）我们将执行 第一次正式探讨艾滋病毒传播的好处和风险 HAART时代的CTR。调查人员有一个证明记录的生产和 传播有助于确定艾滋病毒患者护理优先事项的调查结果， 临床试验设计和指南制定。我们的目标是，在目前 一项建议是对艾滋病毒优先事项的确定产生同样深远的影响， 测试和预防。

DESCRIPTION (provided by applicant): Of the estimated 800,000 to 900,000 Americans who are currently infected with HIV, it is believed that as many as 275,000 remain unaware of their infection and are therefore without access to life-prolonging care or counseling that could prevent the further spread of the virus. This sobering fact suggests that it is time to reconsider the public health approach to HIV counseling, testing, and referral (HIV CTR) in the United States and to quantify the consequences of failing to provide adequate screening, treatment, and prevention. In the last seven years, our research group has published eighteen peer-reviewed policy evaluations using a computer simulation model of the clinical management and economics of HIV. Our findings have had a direct impact on HIV patient care decisions in the United States. We now propose to expand our model in order to address questions of design and priority setting in HIV CTR. We have two specific aims: (1) we will link our existing disease simulation to a new "screening/intake" model that can portray a broad spectrum of at-risk target populations, clinical settings, and testing/counseling protocols. We will codify the various steps that lead from detection of HIV, through treatment and counseling, to changes in viral infectivity, risky behavior, and disease transmission. We will assemble the most up-to-date clinical, epidemiological, economic, and behavioral data within a single, integrated framework. This will create the first comprehensive, model-based tool for the evaluation of HIV counseling, testing, and referral. (2) We will conduct and disseminate three policy evaluations assessing the impact of expanded HIV CTR services. a) We will evaluate the clinical and economic effects of conformity with the CDC's recently promulgated draft Revised Guidelines for HIV Counseling, Testing, and Referral. b) We will conduct an extensive assessment of alternative CTR intervention designs and provide practical guidance to decision makers wishing to tailor program attributes to population-, and setting-specific needs. c) We will perform the first formal exploration of the transmission benefits and risks of expanded HIV CTR in the HAART era. The investigators have a proven record of producing and disseminating findings that have helped to set priorities in HIV patient care, clinical trial design, and guideline development. Our aim, in the present proposal, is to exert an equally profound impact on priority setting in HIV testing and prevention.