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

描述(申请人提供)：艾滋病毒是非洲的主要死亡原因，但只有一小部分人知道他们的血清状态。艾滋病毒的早期诊断对于治疗感染者以及预防今后的感染至关重要。艾滋病毒检测战略改变了感染者的前景，并通过提高接受治疗的个人的存活率和可能改变艾滋病毒危险行为来塑造流行病的进程。因此，世界卫生组织最近建议，考虑到适当的环境，在高度流行的地区进行选择退出检测。拟议的研究计划将评估检测和危险行为之间的关系，不同检测策略的流行病学影响，以及撒哈拉以南非洲的成本效益。订正提交的文件包括更广泛的地域重点、更多的培训活动、更强有力的机构支助，以及缩小2个目标的范围。该项目有以下具体目标： 1.审查关于撒哈拉以南非洲艾滋病毒咨询和检测与与艾滋病毒性传播有关的危险行为之间关系的证据； 2.评估不同的检测战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，并探讨艾滋病毒检测模型如何为决策过程提供有用的投入。 我将评估以下艾滋病毒检测战略：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的检测，以及基于人群的筛查。我将在抗逆转录病毒治疗的有限和全面可获得性的情况下评估所有战略。我的导师是由经验丰富的NIH资助的调查人员组成的PI和共同PI，他们在艾滋病毒政策建模方面有15年以上的经验。它是我个人在传染病建模、成本效益分析和全球卫生方面的研究目标和培训的产物。对该项目的支持将促进在高度流行地区对艾滋病毒检测作出知情的公共卫生决定，并将使我为评估艾滋病毒治疗和预防干预措施的研究生涯做好准备。

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.