Mathematical Models to Evaluate the Clinical and Economic Impact of Biomedical HIV Prevention Strategies in the United States

Abstract

As the marginal clinical impact returns on innovations to treat and prevent HIV diminish, strategic investments are required for timely and efficient HIV eradication. The overall goal of this dissertation research is to evaluate the potential cost-effectiveness of several pharmacotherapy-related interventions included in the National HIV/AIDS Strategy for the United States in order to inform decision-making and policy design. Rising HIV program costs along with poor results in patient access and service utilization make determining the value of new HIV interventions very important for the vulnerable populations bearing the disease burden. Today, pre-exposure prophylaxis (PrEP) drugs are a short-term solution. Quite soon, programs offering financial incentives for viral suppression are expected to expand. Over the long term, many view the development of a safe and effective HIV vaccine as the only hope to completely eradicate AIDS. I develop a series of mathematical models to examine the clinical and economic impact of financial incentives, PrEP, and HIV vaccines using local and national surveillance data drawing on the results of large clinical trials. Importantly, I examine the potential interaction and competition between PrEP and HIV vaccines which needs to be understood to achieve optimal benefit from the combined use of the two in the coming decades. Lastly, I make policy and R&D investment recommendations aimed to support efficient progress towards the national strategic goals.