Localized economic modeling to support implementation of Whe µEQdiQg Whe HIV ESidePic iQ APeUica¶ initiative
Rather than a homogeneous national epidemic, the HIV epidemic in the United States is a collection of diverse local
microepidemics concentrated primarily in the South, hotspot counties, and large urban centers, with fundamental differences
in health system infrastructure, funding and HIV-related laws and policies across jurisdictions. Recognizing these facts, the
US OaXQcKed WKe aPbLWLRXV µEQdLQJ WKe HIV ESLdePLc (EHE) LQLWLaWLYe LQ FebUXaU\ 2019. TKe SOaQ caOOed IRU an initial
focus on 48 counties accounting for more than 50% of all new HIV diagnoses plus Washington, DC, San Juan, Puerto Rico
and seven states with substantial rural burden to reduce new infections by 75% within 5 years and by 90% within 10 years.
These goals are now challenged by the onset of the global COVID-19 pandemic, which may have severe consequences for
people living with HIV and on HIV microepidemics across the US. Further, with widespread civil protest demanding racial
justice across the US, a value-based approach that accounts for the pervasive racial/ethnic inequities in healthcare access
and explicating key elements of the implementation process needed to reach optimal levels of service delivery are now more
critical than ever in reaching the ambitious targets of the EHE initiative.
We propose to renew our previously-funded R01 JUaQW eQWLWOed ³Localized economic modeling for the treatment
and prevention of HIV/AIDS´ (R01-DA0041747). In this competitive renewal application, we propose an integrated set of
aims, executed in parallel, with the goal of establishing a decision-making platform that considers all strategies relevant to
communities and decision-makers in EHE-targeted jurisdictions, acknowledges COVID-19-related disruptions in access to
services, and integrates new evidence as it emerges. We propose to expand our focal set of evidence-based interventions to
Diagnose, Treat and Prevent HIV infection to also consider the potential impact of the Respond pillar of the EHE initiative;
to work with local communities and public health officials to refine and tailor our analysis to local needs and constraints;
and to extend our geographic focus to cover each of the jurisdictions targeted in phase 1 of the EHE initiative, applying a
novel approach, distributional cost-effectiveness analysis, to simultaneously maximize the impact of local HIV responses
and reduce racial/ethnic inequities in healthcare access.