Cost-Effectiveness of Preventing Acute-Phase HIV Transmission

描述(由申请人提供)：需要新的干预策略来将美国的艾滋病毒发病率降低到目前的40K高原以下。最初感染的高传染性急性期是行为改变干预措施的一个有希望但相对未被探索的目标。识别急性感染者并帮助他们降低将病毒传播给其他人的风险的干预措施，可以在努力将艾滋病毒发病率降低到40K以下的平台期发挥重要作用。然而，这些干预措施的最终影响取决于感染急性期的实际传播程度，以及减少急性期艾滋病毒传播的潜在干预措施的成本效益。为了更好地了解艾滋病毒急性传播阶段的流行病学影响，以及在传染性上升时期减少艾滋病毒传播的潜在战略的成本效益，我们将：1)开发数学模型和程序，以估计每年因急性阶段传播而发生的艾滋病毒感染人数、1998年至2004年这类感染的总数，以及为减少急性阶段艾滋病毒传播而采取的干预措施的潜在流行病学和经济影响。2)评估用混合检测样本的艾滋病毒-RNA检测补充现有艾滋病毒咨询和检测服务的效率和成本效益，以促进识别急性感染者，并鼓励减少行为风险，以防止艾滋病毒的急性传播。3)评估成本和估计通过接触后综合预防计划避免的艾滋病毒感染数量，该计划将抗逆转录病毒预防与两次行为风险降低干预或更密集的五次干预相结合。该项目将提供对艾滋病毒急性传播的规模和后果的估计，以及预防感染急性期传播的各种干预战略的潜在经济效益。联邦、州和地方各级的决策者需要这些信息，他们必须优先制定和实施艾滋病毒预防干预措施。研究结果将为科学和政策讨论减少急性期传播干预措施的重要性提供信息。

DESCRIPTION (provided by applicant): Novel intervention strategies are needed to reduce HIV incidence in the US below the current 40K plateau. The highly-infectious acute phase of initial infection represents a promising but relatively unexplored target for behavioral change interventions. Interventions that identify acutely-infected persons and help them reduce their risk of transmitting the virus to others could play an important role in efforts to reduce HIV incidence below the 40K plateau. However, the ultimate impact of these interventions depends on the actual extent of transmission during the acute phase of infection, as well as on the cost-effectiveness of potential interventions to reduce acute-phase HIV transmission. To enhance current understanding of the epidemiological impact of acute-phase HIV transmission and the cost-effectiveness of potential strategies to reduce HIV transmission during this period of elevated infectiousness, we will: 1) Develop mathematical models and procedures to estimate the annual number of incident HIV infections due to acute-phase transmission, the total number of such infections from 1998 through 2004, and the potential epidemiological and economic impact of interventions to reduce acute-phase HIV transmission. 2) Assess the efficiency and cost-effectiveness of supplementing existing HIV counseling and testing services with HIV-RNA testing of pooled test samples to facilitate identification of acutely-infected persons and encourage behavioral risk reduction to prevent acute-phase HIV transmission. 3) Assess the costs and estimate the number of HIV infections averted by a comprehensive post-exposure prophylaxis program that combined antiretroviral prophylaxis with either a 2-session behavioral risk reduction intervention or a more intensive 5-session intervention. This project will provide estimates of the magnitude and consequences of acute-phase HIV transmission, and the potential economic efficiency of various intervention strategies to prevent transmission during the acute phase of infection. This information is needed by decision makers at federal, state, and local levels who must prioritize HIV prevention intervention development and implementation. The results will inform scientific and policy discussions on the importance of interventions to reduce acute-phase transmission.