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Allocating HIV prevention funds in the United States: recommendations from an optimization model.

Lasry A, Sansom SL, Hicks KA, Uzunangelov V - PLoS ONE (2012)

Bottom Line: Model results can be summarized into three main recommendations.Second, counseling and education interventions ought to provide a greater focus on HIV positive persons who are aware of their status.The main conclusions of the HIV resource allocation model have played a role in the introduction of new programs and provide valuable guidance to target resources and improve the impact of HIV prevention efforts in the United States.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. alasry@cdc.gov

ABSTRACT
The Centers for Disease Control and Prevention (CDC) had an annual budget of approximately $327 million to fund health departments and community-based organizations for core HIV testing and prevention programs domestically between 2001 and 2006. Annual HIV incidence has been relatively stable since the year 2000 and was estimated at 48,600 cases in 2006 and 48,100 in 2009. Using estimates on HIV incidence, prevalence, prevention program costs and benefits, and current spending, we created an HIV resource allocation model that can generate a mathematically optimal allocation of the Division of HIV/AIDS Prevention's extramural budget for HIV testing, and counseling and education programs. The model's data inputs and methods were reviewed by subject matter experts internal and external to the CDC via an extensive validation process. The model projects the HIV epidemic for the United States under different allocation strategies under a fixed budget. Our objective is to support national HIV prevention planning efforts and inform the decision-making process for HIV resource allocation. Model results can be summarized into three main recommendations. First, more funds should be allocated to testing and these should further target men who have sex with men and injecting drug users. Second, counseling and education interventions ought to provide a greater focus on HIV positive persons who are aware of their status. And lastly, interventions should target those at high risk for transmitting or acquiring HIV, rather than lower-risk members of the general population. The main conclusions of the HIV resource allocation model have played a role in the introduction of new programs and provide valuable guidance to target resources and improve the impact of HIV prevention efforts in the United States.

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Annual and cumulative number of new HIV infections over 5 years.
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pone-0037545-g001: Annual and cumulative number of new HIV infections over 5 years.

Mentions: The epidemic estimates predicted by the model are presented in Figure 1. The cumulative number of new HIV infections over five years predicted by the model is 192,000 under an optimized allocation of the $327 million budget, 223,000 in the baseline scenario which assumes the current allocation of the $327 million budget and 252,000 assuming no allocation of funds. Thus the baseline allocation averts 13% of new infections when comparing no allocation of funds and the optimized allocation averts 31% of new infections when comparing no allocation of funds. The gap in annual incidence between no allocation and the baseline allocation steadily increased from 4% in the first year of the time horizon to 20% in the fifth and last year. In the first year, the incidence in the optimized allocation represents a 9% reduction relative to the no allocation; because the effects of decreased transmissions accumulate over time, this gap widens and the annual incidence in the fifth year only represents a 48% reduction in the optimized allocation relative to the no allocation. Over the five year horizon, the breakdown of new infections by risk group is approximately 30% HRH, 60% MSM and 10% IDU and is consistent across the optimized, baseline and no allocation strategies.


Allocating HIV prevention funds in the United States: recommendations from an optimization model.

Lasry A, Sansom SL, Hicks KA, Uzunangelov V - PLoS ONE (2012)

Annual and cumulative number of new HIV infections over 5 years.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368881&req=5

pone-0037545-g001: Annual and cumulative number of new HIV infections over 5 years.
Mentions: The epidemic estimates predicted by the model are presented in Figure 1. The cumulative number of new HIV infections over five years predicted by the model is 192,000 under an optimized allocation of the $327 million budget, 223,000 in the baseline scenario which assumes the current allocation of the $327 million budget and 252,000 assuming no allocation of funds. Thus the baseline allocation averts 13% of new infections when comparing no allocation of funds and the optimized allocation averts 31% of new infections when comparing no allocation of funds. The gap in annual incidence between no allocation and the baseline allocation steadily increased from 4% in the first year of the time horizon to 20% in the fifth and last year. In the first year, the incidence in the optimized allocation represents a 9% reduction relative to the no allocation; because the effects of decreased transmissions accumulate over time, this gap widens and the annual incidence in the fifth year only represents a 48% reduction in the optimized allocation relative to the no allocation. Over the five year horizon, the breakdown of new infections by risk group is approximately 30% HRH, 60% MSM and 10% IDU and is consistent across the optimized, baseline and no allocation strategies.

Bottom Line: Model results can be summarized into three main recommendations.Second, counseling and education interventions ought to provide a greater focus on HIV positive persons who are aware of their status.The main conclusions of the HIV resource allocation model have played a role in the introduction of new programs and provide valuable guidance to target resources and improve the impact of HIV prevention efforts in the United States.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. alasry@cdc.gov

ABSTRACT
The Centers for Disease Control and Prevention (CDC) had an annual budget of approximately $327 million to fund health departments and community-based organizations for core HIV testing and prevention programs domestically between 2001 and 2006. Annual HIV incidence has been relatively stable since the year 2000 and was estimated at 48,600 cases in 2006 and 48,100 in 2009. Using estimates on HIV incidence, prevalence, prevention program costs and benefits, and current spending, we created an HIV resource allocation model that can generate a mathematically optimal allocation of the Division of HIV/AIDS Prevention's extramural budget for HIV testing, and counseling and education programs. The model's data inputs and methods were reviewed by subject matter experts internal and external to the CDC via an extensive validation process. The model projects the HIV epidemic for the United States under different allocation strategies under a fixed budget. Our objective is to support national HIV prevention planning efforts and inform the decision-making process for HIV resource allocation. Model results can be summarized into three main recommendations. First, more funds should be allocated to testing and these should further target men who have sex with men and injecting drug users. Second, counseling and education interventions ought to provide a greater focus on HIV positive persons who are aware of their status. And lastly, interventions should target those at high risk for transmitting or acquiring HIV, rather than lower-risk members of the general population. The main conclusions of the HIV resource allocation model have played a role in the introduction of new programs and provide valuable guidance to target resources and improve the impact of HIV prevention efforts in the United States.

Show MeSH
Related in: MedlinePlus