HIV/AIDS Policy Modeling for the U.S.
While global attention is focused on HIV/AIDS in Africa and the developing world, it remains a serious health problem in urban America and the leading cause of death in many segments of the U.S. population, including young African-American women and men, and others who are sexually exposed to intravenous drug users and their partners. A team of investigators, based at the Massachusetts General Hospital, the Center fro Health Decision Science, Brigham and Women's Hospital, and Yale University, is using a mathematical simulation model to compare the health outcomes and costs associated with alternative treatment strategies for individuals with HIV/AIDS. Among the questions that the group has analyzed are: whether the recent change in clinical guidelines that calls for initiation of anti-retroviral treatment earlier in the progression of the disease (CD4 cell counts < 500/ml) than had been recommended previously (CD4 cell counts < 350/ml) is cost-effective; the extent to which failure to identify and treat women and minorities leads to widening disparities in health outcomes; and whether universal or periodic testing for HIV infection is warranted in the U.S.. The CEPAC (Cost-Effectiveness of Preventing AIDS Complications) team works closely with NIH-sponsored clinical trials investigators to extrapolate findings from clinical trials to lifetime outcomes and to study the value of performing particular clinical trials based on the potential impact of outcomes and/or costs of care.