Improving the Public Health Impact of HIV Testing in Highly Endemic Regions

描述（由申请人提供）：艾滋病毒是非洲的主要死因，但只有一小部分人知道自己的血清状况。艾滋病毒的早期诊断对于治疗感染者以及预防未来感染至关重要。艾滋病毒检测策略改变了受感染者的前景，并通过提高接受治疗者的生存率和可能改变艾滋病毒风险行为来塑造流行病的进程。因此，世界卫生组织最近建议，在适当的环境下，在高流行地区选择退出检测。拟议的研究计划将评估测试和危险行为之间的关系，不同的测试策略的流行病学影响，以及在撒哈拉以南非洲地区的成本效益。修订后的呈件包括更广泛的地理重点、额外的培训活动、更强有力的机构支持以及缩小了两个目标的范围。该项目的具体目标如下： 1.审查撒哈拉以南非洲地区艾滋病毒咨询和检测与艾滋病毒性传播风险行为之间关系的证据; 2.评估不同的检测策略如何影响撒哈拉以南非洲的艾滋病毒流行结果，包括流行率、发病率、避免的感染和与艾滋病毒有关的死亡; 3.评估撒哈拉以南非洲不同艾滋病毒检测战略的有效性和成本效益; 4.了解政策制定者如何使用模型，并探索艾滋病毒检测模型如何为政策制定过程提供有用的投入。 我将评估以下艾滋病毒检测策略：自愿咨询和检测（VCT），扩大VCT，提供者发起的咨询和检测，提供者发起的有限咨询检测，以及基于人群的筛查。我将在有限和充分提供抗逆转录病毒疗法的情况下评估所有战略。我的指导PI和共同PI的经验丰富的NIH资助的研究人员与15年以上的经验与艾滋病毒政策建模。它是我个人研究目标和传染病建模、成本效益分析和全球健康培训的产物。对该项目的支持将促进在高度流行地区进行艾滋病毒检测的知情公共卫生决策，并将为我的研究生涯做好准备，评估艾滋病毒治疗和预防干预措施。

DESCRIPTION (provided by applicant): HIV is the leading cause of death in Africa, but only a small portion of the population is aware of their serostatus. Early diagnosis of HIV is essential for treatment of infected individuals as well as for prevention of future infections. HIV testing strategies change the prospects for infected individuals, and shape the course of the epidemic by improving survival of treated individuals and possibly changing HIV risk behaviors. As a result, the World Health Organization recently recommended opt-out testing in highly endemic regions, given the appropriate environment. The proposed research plan will evaluate the relationship between testing and risk behaviors, the epidemiologic implications of different testing strategies, and the cost- effectiveness in sub-Saharan Africa. The revised submission includes a broader geographical focus, additional training activities, stronger institutional support, and a narrowed scope for 2 aims. The project has the following specific aims: 1. Review the evidence on the relationship between HIV counseling and testing and risk behaviors related to sexual transmission of HIV in sub-Saharan Africa; 2. Assess how different testing strategies affect HIV epidemic outcomes in sub-Saharan Africa including prevalence, incidence, infections averted, and HIV-related deaths; 3. Evaluate the effectiveness and cost-effectiveness of different HIV testing strategies in sub- Saharan Africa; 4. Understand how policy makers use models and explore the ways in which models of HIV testing can provide useful inputs to the policy making process. I will evaluate the following HIV testing strategies: voluntary counseling and testing (VCT), scaled up VCT, provider-initiated counseling and testing, provider-initiated testing with limited counseling, and population-based screening. I will evaluate all strategies with limited and full availability of antiretroviral therapy. I am mentored by the PI and co-PI of experienced NIH-funded investigators with 15+ years of experience with HIV policy modeling. It is a product of my personal research objectives and training in infectious disease modeling, cost-effectiveness analysis, and global health. Support for this project will promote informed public health decisions for HIV testing in highly endemic regions, and will prepare me for a research career evaluating HIV treatment and prevention interventions.