Of the roughly 900,000 Americans who are currently infected with HIV, as many as 280,000 remain unaware of their infection and without access to life-prolonging services that could prevent the further spread of the virus. In 2002, we were awarded funding to develop a computer simulation model of HIV counseling, testing, and referral (HIVCTR) and the clinical management and economics of HIV. Over the last 2 years, we have achieved our project objectives.
Our aims, in this continuation proposal, are: 1. To refine our simulation model of HIVCTR system performance and the impact of decisions on patient quality of life and behavior. 2. To conduct a series of policy evaluations on the value and design of expanded HIVCTR services. We will: 1. Define the circumstances under which newly approved, rapid HIV testing protocols are preferred to traditional antibody tests; 2. Estimate the long-run benefits and costs of real-time screening for primary HIV infection; 3. Examine how HIV testing outcomes translate into population-level changes in disease incidence and explore the possible impact of reduced transmission on estimates of the cost-effectiveness of expanded HIVCTR; 4. Project the downstream financial impact of increased case identification and referral to care on the demand for publicly funded HIV services, including Medicaid, the Ryan White CARE Act, and state AIDS Drug Assistance Programs (ADAPS). Over the last 10 years, our research team has established a record of publishing and disseminating findings that inform national priority setting in HIV patient care, clinical trial design, and practice guideline development. During the initial funding cycle of this project, we have demonstrated our potential to exert an equally profound impact in the area of HIV testing and prevention policy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
2R01MH065869-04
Application #
6946998
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Grossman, Cynthia I
Project Start
2002-07-01
Project End
2008-06-30
Budget Start
2005-07-01
Budget End
2006-06-30
Support Year
4
Fiscal Year
2005
Total Cost
$492,426
Indirect Cost
Name
Yale University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Martin, Erika G; Wang, Karen H (2013) Integrating substance abuse treatment into HIV care: missed opportunities in the AIDS Drug Assistance Program. J Acquir Immune Defic Syndr 62:421-9
Yazdanpanah, Yazdan; Perelman, Julian; DiLorenzo, Madeline A et al. (2013) Routine HIV screening in Portugal: clinical impact and cost-effectiveness. PLoS One 8:e84173
Schackman, Bruce R; Metsch, Lisa R; Colfax, Grant N et al. (2013) The cost-effectiveness of rapid HIV testing in substance abuse treatment: results of a randomized trial. Drug Alcohol Depend 128:90-7
Martin, Erika G; Meehan, Terence; Schackman, Bruce R (2013) AIDS Drug Assistance Programs: managers confront uncertainty and need to adapt as the Affordable Care Act kicks in. Health Aff (Millwood) 32:1063-71
Martin, Erika G; Schackman, Bruce R (2012) What does U.S. health reform mean for HIV clinical care? J Acquir Immune Defic Syndr 60:72-6
Arbelaez, Christian; Wright, Elizabeth A; Losina, Elena et al. (2012) Emergency provider attitudes and barriers to universal HIV testing in the emergency department. J Emerg Med 42:7-14
Walensky, Rochelle P; Park, Ji-Eun; Wood, Robin et al. (2012) The cost-effectiveness of pre-exposure prophylaxis for HIV infection in South African women. Clin Infect Dis 54:1504-13
Paltiel, A David; Walensky, Rochelle P (2012) Home HIV testing: good news but not a game changer. Ann Intern Med 157:744-6
April, Michael D; Chiosi, John J; Paltiel, A David et al. (2011) Projected survival gains from revising state laws requiring written opt-in consent for HIV testing. J Gen Intern Med 26:661-7
Reichmann, William M; Walensky, Rochelle P; Case, Amy et al. (2011) Estimation of the prevalence of undiagnosed and diagnosed HIV in an urban emergency department. PLoS One 6:e27701

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