This project examines the allocation of resources to the treatment and prevention of HIV/AIDS and the role of screening and treatment for depression among women living with HIV (WLWH). HIV is no longer a death sentence for those infected, and the disease is becoming like other chronic diseases. As a result, comorbidities are becoming a greater concern. Of common comorbidities, depression is arguably the most important, especially for women. Depression shapes key aspects of HIV care, such as retention in care. This project will evaluate the impact of screening and treatment of depression among WLWH on the public and social costs of HIV/AIDS and on the allocation of resources to treatment and prevention of HIV. In doing so, we consider not just the costs of treatment but also the productivity costs-the effect on employment, disability, and other public expenditures. Our research approach involves integration of simulation modeling with new methodologies in cost effectiveness research, including a portfolio-based approach.
When completed, this project will answer key questions: (1) What allocation of HIV/AIDS-related expendi-tures between treatment and prevention produces the best levels of HIV/AIDS and employment among women in the community? (2) What portion of a budget should be allocated to identifying and treating depression among HIV+ women? (3) How would screening for depression among HIV+ women affect expenditures on HIV treatment and on depression? (4) Do WLWH who are treated for depression remain in the labor force longer, staying off disability and public insurance? (5) How does the best mix of expenditures depend on community characteristics, such as labor market conditions and public insurance, such as the Medicaid program?
