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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01AI084582-05
Application #
8510558
Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Mckaig, Rosemary G
Project Start
2009-09-15
Project End
2014-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
5
Fiscal Year
2013
Total Cost
$130,519
Indirect Cost
$9,668
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Bendavid, Eran (2016) Past and Future Performance: PEPFAR in the Landscape of Foreign Aid for Health. Curr HIV/AIDS Rep 13:256-62
Suen, S-C; Bendavid, E; Goldhaber-Fiebert, J D (2015) Cost-effectiveness of improvements in diagnosis and treatment accessibility for tuberculosis control in India. Int J Tuberc Lung Dis 19:1115-24, i-xv
Desai, Manisha; Joyce, Vilija; Bendavid, Eran et al. (2015) Risk of cardiovascular events associated with current exposure to HIV antiretroviral therapies in a US veteran population. Clin Infect Dis 61:445-52
Bendavid, Eran; Bhattacharya, Jay (2014) The relationship of health aid to population health improvements. JAMA Intern Med 174:881-7
Suen, Sze-Chuan; Bendavid, Eran; Goldhaber-Fiebert, Jeremy D (2014) Disease control implications of India's changing multi-drug resistant tuberculosis epidemic. PLoS One 9:e89822
Bendavid, Eran (2014) Changes in child mortality over time across the wealth gradient in less-developed countries. Pediatrics 134:e1551-9
Alistar, Sabina S; Grant, Philip M; Bendavid, Eran (2014) Comparative effectiveness and cost-effectiveness of antiretroviral therapy and pre-exposure prophylaxis for HIV prevention in South Africa. BMC Med 12:46
Bendavid, Eran; Holmes, Charles B; Bhattacharya, Jay et al. (2012) HIV development assistance and adult mortality in Africa. JAMA 307:2060-7
Negoescu, Diana M; Owens, Douglas K; Brandeau, Margaret L et al. (2012) Balancing immunological benefits and cardiovascular risks of antiretroviral therapy: when is immediate treatment optimal? Clin Infect Dis 55:1392-9
Juusola, Jessie L; Brandeau, Margaret L; Owens, Douglas K et al. (2012) The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men. Ann Intern Med 156:541-50

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