HIV Prevention, Cost-Utility Analysis and Race/Ethnicity

描述(由申请人提供)：自1990年以来，美国的艾滋病毒发病率几乎保持在每年40,000例感染病例。然而，受艾滋病毒和艾滋病影响最严重的社区已经发生了变化。从1981年到1987年，非洲裔美国人占艾滋病病例的25.5%，而在1996年到2000年，这一比例为44.9%。在同一时期，拉美裔社区占艾滋病病例的比例从14.0%上升到19.7%，而白人、非西班牙裔占艾滋病病例的比例在同一时期从59.7%下降到34.0%。亚洲/太平洋岛民和美洲原住民/美国印第安人/阿拉斯加原住民在两个时间框架内艾滋病病例的比例都保持在1%以下。尽管存在这些明显的差异，但艾滋病毒预防行为干预研究发现，针对种族/少数民族社区的干预措施发展滞后。此外，在关于艾滋病毒预防干预措施成本效益的整个文献中，只对专门针对种族/少数民族社区的干预措施进行了两项经济评价研究。分配艾滋病毒预防服务资金的政策制定者必须了解各种艾滋病毒预防干预措施的成本和后果，以便就如何利用现有资源作出明智的决定，从而最大限度地增加不同社区的艾滋病毒感染人数。虽然这两项研究都遵循了进行成本效益分析的一般方法建议，但这些建议并不特别侧重于涉及种族/少数民族社区的研究。因此，在艾滋病毒预防领域需要注意更多的方法工作和更多地应用这种方法，重点是受艾滋病毒/艾滋病流行病影响特别大的种族/族裔少数群体。我们建议在这个为期一年的项目中关注其中一些问题。拟议项目的具体目标如下：将最先进的成本效益分析方法(追溯)应用于针对非裔美国人的两种不同的艾滋病毒预防行为干预措施--一种侧重于男同性恋和双性恋男子，另一种侧重于艾滋病毒血清状况不明的妇女--以衡量这些预防服务的成本效益。在两个独立的应用研究中，我们将使用最先进的方法将艾滋病毒预防行为干预归类为节省成本、成本有效或成本无效。我们假设，与干预的比较条件相比，每个行为干预都会节省成本。我们还将使用广泛的敏感性分析，以确定可能受到与种族/族裔有关的文化和/或社会因素影响的参数可能在多大程度上影响成本效益分析结果，并全面报告这些敏感性分析。我们建议在科学期刊上发表这些发现，并以严谨而简洁的方式总结这些发现，以供艾滋病毒预防优先决策者使用。

DESCRIPTION (provided by applicant): Since 1990, HIV incidence in the U.S. has been approximately constant at 40,000 infections per year. However, the communities most heavily impacted by HIV and AIDS have changed. African-American persons comprised 25.5% of AIDS cases from 1981 to 1987, but 44.9% during 1996 to 2000. Latino communities increased from 14.0% to 19.7% of AIDS cases during the same time frames, and White, non-Hispanic persons fraction of AIDS cases dropped from 59.7% to 34.0% during those time periods. Asian/Pacific Islander and Native American/American Indian/Alaskan Native proportions of AIDS cases stayed under 1% in both time frames. Despite these clear disparities, HIV prevention behavioral intervention research has seen a lag in the development of interventions for racial/ethnic minority communities. Further, in the entire literature on the cost-effectiveness of HIV prevention interventions, only two economic evaluation studies have been conducted on interventions designed specifically for racial/ethnic minority communities. Policymakers who allocate HIV prevention service funds must know about the costs and consequences of various types of HIV prevention interventions in order to make sound decisions about how to use available resources so as to maximize the number of HIV infections in various communities. Although both of these studies followed general methodological recommendations for conducting cost-effectiveness analyses, these recommendations are not focused specifically for studies involving racial/ethnic minority communities. Therefore, more methodological work and more applications of such methods needs attention in the field of HIV prevention as focused on racial/ethnic minority communities disproportionately impacted by the HIV/AIDS epidemic. We propose to attend to some of these issues in this one-year project. The specific aims of the proposed project are as follows: To apply state-of-the-art cost-utility analysis methods (retrospectively) to two separate HIV prevention behavioral interventions for African American persons - one focused on gay and bisexual men, and one focused on women of undetermined HIV serostatus - so as to gauge the cost-effectiveness of these prevention services. In each of the two separate application studies, we will use the state-of-the-art methods to classify the HIV prevention behavioral intervention as either cost saving, cost-effective or cost inefficient. We hypothesize that each behavioral intervention will be cost saving relative to the comparison condition for that intervention. We will also use extensive sensitivity analyses to determine the extent to which parameters that may be influenced by cultural and/or societal factors related to race/ethnicity might influence the cost-utility analytic results and report fully on these sensitivity analyses. We propose to publish the findings in scientific journals and summarize the findings in a rigorous yet succinct manner for HIV prevention priority setters.