HIV Prevention, Cost-Utility Analysis and Race/Ethnicity

DESCRIPTION (provided by applicant): Since 1990, HIV incidence in the U.S. has been approximately constant at 40,000 infections per year. However, the communities most heavily impacted by HIV and AIDS have changed. African-American persons comprised 25.5% of AIDS cases from 1981 to 1987, but 44.9% during 1996 to 2000. Latino communities increased from 14.0% to 19.7% of AIDS cases during the same time frames, and White, non-Hispanic persons fraction of AIDS cases dropped from 59.7% to 34.0% during those time periods. Asian/Pacific Islander and Native American/American Indian/Alaskan Native proportions of AIDS cases stayed under 1% in both time frames. Despite these clear disparities, HIV prevention behavioral intervention research has seen a lag in the development of interventions for racial/ethnic minority communities. Further, in the entire literature on the cost-effectiveness of HIV prevention interventions, only two economic evaluation studies have been conducted on interventions designed specifically for racial/ethnic minority communities. Policymakers who allocate HIV prevention service funds must know about the costs and consequences of various types of HIV prevention interventions in order to make sound decisions about how to use available resources so as to maximize the number of HIV infections in various communities. Although both of these studies followed general methodological recommendations for conducting cost-effectiveness analyses, these recommendations are not focused specifically for studies involving racial/ethnic minority communities. Therefore, more methodological work and more applications of such methods needs attention in the field of HIV prevention as focused on racial/ethnic minority communities disproportionately impacted by the HIV/AIDS epidemic. We propose to attend to some of these issues in this one-year project. The specific aims of the proposed project are as follows: To apply state-of-the-art cost-utility analysis methods (retrospectively) to two separate HIV prevention behavioral interventions for African American persons - one focused on gay and bisexual men, and one focused on women of undetermined HIV serostatus - so as to gauge the cost-effectiveness of these prevention services. In each of the two separate application studies, we will use the state-of-the-art methods to classify the HIV prevention behavioral intervention as either cost saving, cost-effective or cost inefficient. We hypothesize that each behavioral intervention will be cost saving relative to the comparison condition for that intervention. We will also use extensive sensitivity analyses to determine the extent to which parameters that may be influenced by cultural and/or societal factors related to race/ethnicity might influence the cost-utility analytic results and report fully on these sensitivity analyses. We propose to publish the findings in scientific journals and summarize the findings in a rigorous yet succinct manner for HIV prevention priority setters.