Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Yaylali E [original query] |
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Optimal allocation of HIV prevention funds for state health departments
Yaylali E , Farnham PG , Cohen S , Purcell DW , Hauck H , Sansom SL . PLoS One 2018 13 (5) e0197421 OBJECTIVE: To estimate the optimal allocation of Centers for Disease Control and Prevention (CDC) HIV prevention funds for health departments in 52 jurisdictions, incorporating Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program funds, to improve outcomes along the HIV care continuum and prevent infections. METHODS: Using surveillance data from 2010 to 2012 and budgetary data from 2012, we divided the 52 health departments into 5 groups varying by number of persons living with diagnosed HIV (PLWDH), median annual CDC HIV prevention budget, and median annual HRSA expenditures supporting linkage to care, retention in care, and adherence to antiretroviral therapy. Using an optimization and a Bernoulli process model, we solved for the optimal CDC prevention budget allocation for each health department group. The optimal allocation distributed the funds across prevention interventions and populations at risk for HIV to prevent the greatest number of new HIV cases annually. RESULTS: Both the HIV prevention interventions funded by the optimal allocation of CDC HIV prevention funds and the proportions of the budget allocated were similar across health department groups, particularly those representing the large majority of PLWDH. Consistently funded interventions included testing, partner services and linkage to care and interventions for men who have sex with men (MSM). Sensitivity analyses showed that the optimal allocation shifted when there were differences in transmission category proportions and progress along the HIV care continuum. CONCLUSION: The robustness of the results suggests that most health departments can use these analyses to guide the investment of CDC HIV prevention funds into strategies to prevent the most new cases of HIV. |
Impact of improved HIV care and treatment on PrEP effectivenesss in the United States, 2016-2020
Khurana N , Yaylali E , Farnham PG , Hicks KA , Allaire BT , Jacobson E , Sansom SL . J Acquir Immune Defic Syndr 2018 78 (4) 399-405 BACKGROUND: The effect of improving diagnosis, care, and treatment of persons living with HIV (PLWH) on PrEP effectiveness in the United States has not be well established. METHODS: We used a dynamic, compartmental model that simulates the sexually active US population. We investigated the change in cumulative HIV incidence from 2016 to 2020 for three HIV care continuum levels, and the marginal benefit of PrEP compared with each. We also explored the marginal benefit of PrEP for individual risk groups, and as PrEP adherence, coverage and dropout rates varied. RESULTS: Delivering PrEP in 2016 to persons at high risk of acquiring HIV resulted in an 18.1% reduction in new HIV infections from 2016 to 2020 under current care continuum levels. Achieving HIV national goals of 90% of PLWH with diagnosed infection, 85% of newly diagnosed PLWH linked to care at diagnosis, and 80% of diagnosed PLWH virally suppressed reduced cumulative incidence by 34.4%. Delivery of PrEP in addition to this scenario resulted in a marginal benefit of 11.1% additional infections prevented. When national goals were reached, PrEP prevented an additional 15.2% cases among men who have sex with men (MSM), 3.9% among heterosexuals, and 3.8% among persons who inject drugs. CONCLUSIONS: The marginal benefit of PrEP was larger when current HIV care continuum percentages were maintained, but continued to be substantial even when national care goals were met. The high-risk MSM population was the chief beneficiary of PrEP. |
Cost-effectiveness of frequent HIV testing of high risk populations in the United States
Hutchinson AB , Farnham PG , Sansom SL , Yaylali E , Mermin JH . J Acquir Immune Defic Syndr 2015 71 (3) 323-30 PURPOSE: Data showing a high incidence of HIV infection among men who have sex with men (MSM) who had annual testing suggest that more frequent HIV testing may be warranted. Testing technology is also a consideration given the availability of sensitive testing modalities as well as the increased use of less sensitive rapid, point-of-care antibody tests. We assessed the cost-effectiveness of HIV testing of MSM and injection drug users (IDUs) at 3- and 6-month intervals using fourth-generation and rapid tests. METHODS: We used a published mathematical model of HIV transmission to evaluate testing intervals for each population using cohorts of 10,000 MSM and IDU. We incorporated HIV transmissions averted due to serostatus awareness and viral suppression. We included costs for HIV testing and treatment initiation, as well as treatment costs saved from averted transmissions. RESULTS: For MSM, HIV testing was cost-saving or cost-effective over a 1-year time period for both 6-month compared to annual testing, and quarterly compared to 6-month testing using either test. Testing IDU every 6 months compared to annually was moderately cost-effective over a 1-year time period with a fourth-generation test, while testing with rapid, point-of care tests or quarterly was not cost-effective. MSM results remained robust in sensitivity analysis, while IDU results were sensitive to changes in HIV incidence and continuum-of-care parameters. Threshold analyses on costs suggested additional implementation costs could be incurred for more frequent testing for MSM while remaining cost-effective. CONCLUSION: HIV testing of MSM as frequently as quarterly is cost-effective compared to annual testing, but testing IDU more frequently than annually is generally not cost-effective. |
From theory to practice: Implementation of a resource allocation model in health departments
Yaylali E , Farnham PG , Schneider KL , Landers SJ , Kouzouian O , Lasry A , Purcell DW , Green TA , Sansom SL . J Public Health Manag Pract 2015 22 (6) 567-75 OBJECTIVE: To develop a resource allocation model to optimize health departments' Centers for Disease Control and Prevention (CDC)-funded HIV prevention budgets to prevent the most new cases of HIV infection and to evaluate the model's implementation in 4 health departments. DESIGN, SETTINGS, AND PARTICIPANTS: We developed a linear programming model combined with a Bernoulli process model that allocated a fixed budget among HIV prevention interventions and risk subpopulations to maximize the number of new infections prevented. The model, which required epidemiologic, behavioral, budgetary, and programmatic data, was implemented in health departments in Philadelphia, Chicago, Alabama, and Nebraska. MAIN OUTCOME MEASURES: The optimal allocation of funds, the site-specific cost per case of HIV infection prevented rankings by intervention, and the expected number of HIV cases prevented. RESULTS: The model suggested allocating funds to HIV testing and continuum-of-care interventions in all 4 health departments. The most cost-effective intervention for all sites was HIV testing in nonclinical settings for men who have sex with men, and the least cost-effective interventions were behavioral interventions for HIV-negative persons. The pilot sites required 3 to 4 months of technical assistance to develop data inputs and generate and interpret the results. Although the sites found the model easy to use in providing quantitative evidence for allocating HIV prevention resources, they criticized the exclusion of structural interventions and the use of the model to allocate only CDC funds. CONCLUSIONS: Resource allocation models have the potential to improve the allocation of limited HIV prevention resources and can be used as a decision-making guide for state and local health departments. Using such models may require substantial staff time and technical assistance. These model results emphasize the allocation of CDC funds toward testing and continuum-of-care interventions and populations at highest risk of HIV transmission. |
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- Page last updated:Jun 24, 2024
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