Health Affairs

Health Affairs, 24, no. 6 (2005): 1683 doi: 10.1377/hlthaff.24.6.1683 © 2005 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Letters

CDC: HIV Prevention Efforts

The initiative Advancing HIV Prevention (AHP) is an important focus at the CDC. Funding for this initiative, however, is a minority of the resources distributed by the CDC for HIV/AIDS prevention. The CDC supports a comprehensive approach to public health action designed to prevent HIV infections and minimize disability and death from this condition. A portfolio of funded interventions includes almost all of those identified as cost-effective. The exception: As noted by the authors, the CDC does not support needle exchange, because it is prohibited by federal law.

The choice and calculation in the authors’ model created an incomplete evaluation of the CDC’s prevention approach. Their outcome measure was "infections prevented." Indeed, decreasing the number of new HIV infections is a central goal of the CDC mission. But using a comprehensive measure such as the standard quality-adjusted life year (QALY) saved would have more thoroughly captured the beneficial effects of expanded testing programs that result from early diagnosis and treatment.¹

In addition, the authors stated that the number of reported HIV diagnoses in 2002 was 26,000 cases, when the source document for these data clearly describes that the areas included in the analysis only cover about half of the HIV cases diagnosed in the United States.² This specification error in the model, combined with an incomplete review of studies that demonstrate the effectiveness of interventions for HIV-positive people, resulted in greatly underestimating the overall potential benefit of partner counseling and referral, as well as prevention case management.

Robert S. Janssen and Matthew T. McKenna

NOTES

1. See, for example, "Treating Opportunistic Infections among HIV-Infected Adults and Adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America," Morbidity and Mortality Weekly Report 53, no. RR-15 (2004); A.D. Paltiel et al., "Expanded Screening for HIV in the United States: An Analysis of Cost-Effectiveness," New England Journal of Medicine 352, no. 6 (2005): 586–595[Abstract/Free Full Text]; and G.D. Sanders et al., "Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral Therapy," New England Journal of Medicine 352, no. 6 (2005): 570–585.[Abstract/Free Full Text]
2. U.S. Centers for Disease Control and Prevention, "Commentary," in Cases of HIV Infection and AIDS in the United States, 2002, HIV/AIDS Surveillance Report, vol. 14, www.cdc.gov/hiv/stats/hasr1402/2002SurveillanceReport.pdf (3 October 2005), 5–9.

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