HIV Treatment and Prevention

Juusola, Jessie; Brandeau, Margaret L.

doi:10.1177/0272989x15598528

Cited by 23 publications

(23 citation statements)

References 54 publications

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“…31 , 32 It adds to a growing body of literature on resource allocation for HIV prevention, which highlights the need to account for local epidemiology to maximise the efficiency of HIV prevention planning. 6 , 33 , 34 , 35 , 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study

et al. 2016

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SummaryBackgroundMany ways of preventing HIV infection have been proposed and more are being developed. We sought to construct a strategic approach to HIV prevention that would use limited resources to achieve the greatest possible prevention impact through the use of interventions available today and in the coming years.MethodsWe developed a deterministic compartmental model of heterosexual HIV transmission in South Africa and formed assumptions about the costs and effects of a range of interventions, encompassing the further scale-up of existing interventions (promoting condom use, male circumcision, early antiretroviral therapy [ART] initiation for all [including increased HIV testing and counselling activities], and oral pre-exposure prophylaxis [PrEP]), the introduction of new interventions in the medium term (offering intravaginal rings, long-acting injectable antiretroviral drugs) and long term (vaccine, broadly neutralising antibodies [bNAbs]). We examined how available resources could be allocated across these interventions to achieve maximum impact, and assessed how this would be affected by the failure of the interventions to be developed or scaled up.FindingsIf all interventions are available, the optimum mix would place great emphasis on the following: scale-up of male circumcision and early ART initiation with outreach testing, as these are available immediately and assumed to be low cost and highly efficacious; intravaginal rings targeted to sex workers; and vaccines, as these can achieve a large effect if scaled up even if imperfectly efficacious. The optimum mix would rely less on longer term developments, such as long-acting antiretroviral drugs and bNAbs, unless the costs of these reduced. However, if impossible to scale up existing interventions to the extent assumed, emphasis on oral PrEP, intravaginal rings, and long-acting antiretroviral drugs would increase. The long-term effect on the epidemic is most affected by scale-up of existing interventions and the successful development of a vaccine.InterpretationWith current information, a strategic approach in which limited resources are used to maximise prevention impact would focus on strengthening the scale-up of existing interventions, while pursuing a workable vaccine and developing other approaches that can be used if further scale-up of existing interventions is limited.FundingBill & Melinda Gates Foundation.

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Section: Discussionmentioning

confidence: 99%

Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study

et al. 2016

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“…While the use of mathematical optimization techniques to allocate limited HIV resources is not new in the field of health economics [11,8,13,12,4], our approach is unique in emphasizing the capacity of the fixed epidemic assumption (when appropriate) to allow for flexible and robust allocation analyses.…”

Section: Introductionmentioning

confidence: 99%

Feasible and ethical allocation of intervention resources for infectious diseases using linear programming

Gerberry

Blower²

2019

RMTA

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In this work, we demonstrate that the consideration of a fixed epidemic and the use of linear programming can be an effective tool for designing rollout strategies for infectious disease interventions. Specifically, we argue that the approach can be more flexible, more amenable to detailed allocation plans and more in line with the way that public policy decisions are made than standard optimal control allocations. We also show how feasibility and ethical constraints can be incorporated into resource allocations. As an application, we consider the initial rollout of Treatment as Prevention (TasP) resources for HIV (human immunodeficiency virus) in South Africa that began within the last decade. Going back to TasP’s initial rollout allows us to demonstrate the strengths of this approach.

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“…In general, the (incremental) net monetary benefit of an intervention is linear in parameters with a one-time effect (e.g., the prevalence of a disease at one point in time or the outcome of a one-time screening test). When an effect accrues over time, such as for a reduction in the annual transition rate of a disease complication or death, linearity is often used as an approximation (see, e.g., [ 8 ]). At each time, the policy-maker can choose to invest in the medical intervention and/or to purchase sample information about the uncertain dynamic parameter.…”

Section: Introductionmentioning

confidence: 99%

Population-level intervention and information collection in dynamic healthcare policy

Cipriano

Weber

2017

Health Care Manag Sci

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We develop a general framework for optimal health policy design in a dynamic setting. We consider a hypothetical medical intervention for a cohort of patients where one parameter varies across cohorts with imperfectly observable linear dynamics. We seek to identify the optimal time to change the current health intervention policy and the optimal time to collect decision-relevant information. We formulate this problem as a discrete-time, infinite-horizon Markov decision process and we establish structural properties in terms of first and second-order monotonicity. We demonstrate that it is generally optimal to delay information acquisition until an effect on decisions is sufficiently likely. We apply this framework to the evaluation of hepatitis C virus (HCV) screening in the general population determining which birth cohorts to screen for HCV and when to collect information about HCV prevalence.

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HIV Treatment and Prevention

Cited by 23 publications

References 54 publications

Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study

Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study

Feasible and ethical allocation of intervention resources for infectious diseases using linear programming

Population-level intervention and information collection in dynamic healthcare policy

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