Brandeau ML, Lee HL, Owens DK, Sox CH, Wachter RM; International Conference on AIDS.

Int Conf AIDS. 1990 Jun 20-23; 6: 120 (abstract no. S.C.99).

Stanford University, Stanford, California, USA

OBJECTIVE: Policy makers have instituted a variety of interventions aimed at curbing the HIV epidemic (i.e., compulsory premarital screening), often before careful studies of program costs and benefits have been carried out. Furthermore, many existing AIDS policy studies rely on very simple models of cause and effect. The objective of this study is to develop an analytic decision model that can be used to support policy analysis of HIV screening and intervention, and to illustrate the model with an analysis of screening policies aimed at reducing HIV transmission to newborns. METHODS: We develop a dynamic compartmental epidemic model that captures effects such as disease transmission and disease progression, behavioral changes, and effects of screening and other interventions. The model can be used to analyze the effects of a wide range of interventions, including screening programs, educational programs, contact tracing, and substance abuse treatment programs. The model is designed to overcome limitations of existing models, since it allows for evaluation of multiple, dynamic interventions; uses multi-attribute outcome measures (including direct and indirect monetary costs, number of HIV infections, number of deaths from HIV, and number of false positive and false negative screening tests); and can explicitly incorporate the effects of a wide range of behavioral changes in response to interventions. We apply the model (using data from the State of California) to analyze screening programs aimed at reducing the birthrate of HIV-infected infants. RESULTS: We find that screening programs aimed at women in all risk groups do not make economic sense, since the prevalence of HIV infection is too low in the overall female population to justify the screening expenditure. On the other hand, screening high risk women (women who are IVDU's and/or women with many sexual partners) is more than offset by the savings in medical care for HIV-infected infants. This is true over a wide range of assumptions about the fraction of women reached by such a screening program and the magnitude of behavioral change following a positive test. CONCLUSION: A comprehensive model that captures dynamics of the HIV epidemic, as well as behavioral and other effects, provides an improved way to evaluate interventions aimed at curbing the epidemic. A screening program aimed at high risk women may be a cost-effective strategy to decrease perinatal infection, while one aimed at all women would not be cost-effective.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• California
• Disease Transmission, Vertical
• Female
• HIV Infections
• HIV Seropositivity
• Humans
• Infant
• Infant, Newborn
• Mass Screening
• Models, Biological
• Prevalence
• Research
• Sexual Partners
• methods
• transmission

Other ID:

• 30009990

UI: 102195952

From Meeting Abstracts