Despite many years of prevenfion intervenfions targeted at individuals, HIV infecfions confinue to occur at an alarming rate. Increasing attenfion is thus being directed by the research and policy communifies to structural-level interventions, recognizing that prevenfion efforts must not only target individuals and their behaviors, but also focus on the public-sector and private-sector policies that set the context within which HIV prevention, identification and treatment occur. The goal of the Policy Core is to sfimulate research to examine both public and private policies, in order to identify the obstacles and leverage points that they may present to the promotion of HIV detection, prevention and treatment at nafional, state and local levels, as well as internationally. The Core's purview includes data analyses and identification of each link in the policy-making chain that is a potential barrier to or facilitator of science-based acfion: for example, we examined variations in the uptake of male circumcision depending on a state's insurance coverage forthe procedure. If the impacts of the policies are not identified and analyzed, health benefits cannot be realized. The Policy Core strives to disseminate the resulting findings from its analyses to public health and government leaders and the public, so that they have the evidence base necessary for well-informed policy making. The goal of the Policy Core is to bridge the gap between research and policy to make more effecfive the fight against HIV in the U.S. and abroad. The National HIV/AIDS Strategy For The United States stated that one missing element in prior efforts to combat HIV is """"""""community-level approaches to altering the conditions in which HIV is transmitted and addressing the factors that influence disparate health outcomes among people living with HIV..."""""""".^ Public and private policies can promote or stand in the way of implementing communitylevel initiatives that clinical or behavioral research shows to be efficacious. For example, clinical research and computer modeling strongly suggest that initiating eariier ARV treatment to lower an individual's viral load, and thereby reduce overall community viral load, would lessen the transmission of HIV in a community.^ However, implementing this Testing &Linkage to Care Plus Treatment (TLC+) approach is hampered by policies of both private and public insurers, who will pay only for services that the Preventive Services Task Force (PSTF) recommends be routinely offered. Despite the Centers for Disease Prevention and Control (CDC)'s recommendations for routine HIV screening in medical settings,^ the PSTF guidelines endorse only risk-based tesfing, enabling insurers to decline payment for roufine screening, which is an integral component of TLC+. Objective, credible, and unbiased analysis of the cost-effectiveness of the TLC+ approach and disseminafion of this information to policy makers in readily accessible formats, such as Policy Briefs and through legislative tesfimony, could help to remove the barriers to broadly implemenfing efficacious clinical research findings.
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