Robert C. Long Memorial Lecture in Mental Health Services Research

David Holtgrave, PhD
Professor, Center for AIDS Research, Rollins School of Public Health
Professor and Vice-Chair Department of Behavioral Science and Health Education Rollins School of Public Health, Emory University

Defining, Measuring and Ensuring HIV Prevention Effectiveness and Cost-effectiveness

October 29, 2004
12:00 - 1:30 PM
Colonial Penn Center Auditorium

co-sponsored by Center for Mental Health Policy and
Services Research and Penn's Center for AIDS Research

Abstract

From 1997 to 2001, Dr. David Holtgrave was the Director of the Division of HIV/AIDS Prevention: Intervention Research and Support in the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia. The Division has major responsibilities in funding HIV prevention programs, providing technical assistance to HIV prevention service delivery organizations, conducting program evaluation studies, and performing HIV prevention intervention research.

Dr. Holtgrave has worked almost exclusively in the field of HIV prevention since 1991. From 1991 until 1995, he worked at CDC in HIV prevention; from 1995 until 1997 he was an Associate Professor and Associate Center Director at the Center for AIDS Intervention Research at the Medical College of Wisconsin (in 1997 he returned to CDC). His research has focused on the effectiveness and cost-effectiveness of a variety of HIV prevention interventions, and the relation of the findings of these studies to HIV prevention policy making. He has worked extensively on HIV prevention community planning, and has served as a member of the Wisconsin HIV Prevention Community Planning group.

Dr. Holtgrave received his Ph.D. in quantitative psychology in 1988 from the University of Illinois at Urbana/Champaign, and then completed a post-doctoral research fellowship in public health and public policy in the Interdisciplinary Programs in Health at the Harvard University School of Public Health. He has authored or co-authored over 135 professional publications, and has edited The Handbook of Economic Evaluation for HIV Prevention Programs (Plenum Press, 1998). He has been the Principal Investigator on three NIH RO1 grants focused on the cost-effectiveness of HIV primary prevention interventions.

Dr. Holtgrave is committed to halting the transmission of HIV infection by evaluating and implementing culturally competent, scientifically sound, community based HIV prevention programs. This has been the common theme throughout all of his work for well over a decade.

Abstract:
In this presentation, three central questions are addressed: (a) how do we measure HIV prevention effectiveness in the US and what have HIV prevention services accomplished to date?; (b) what are the consequences of meeting or failing to meet CDC's national goal of reducing new HIV infections by 2005?; and (c) what programs, resources, and policies are necessary to reach the national goal? In summary, scenario and economic evaluation studies have found that since the beginning of the HIV epidemic in the U.S., HIV prevention programs have prevented hundreds of thousands of HIV infections, and the investment in these programs has actually been cost-saving to society in terms of medical costs averted. A substantial body of evidence exists (including randomized controlled trials and careful meta-analyses) which demonstrates that various, specific HIV prevention services are effective; an increasingly large body of data also demonstrates the cost-effectiveness (and in some cases, cost savings) of these interventions. However, there is much work to do to meet the national goal of reducing new HIV infections by an additional 50%. If this goal is not met, approximately 130,000 additional HIV infections will occur by 2010 with lifetime medical care cost implications of approximately $18B (compared with a scenario in which the national goal is met). Currently, the efforts to utilize these interventions in a comprehensive HIV prevention programs are hampered by continued unmet service delivery needs, imperfect targeting strategies, and a policy environment that creates barriers to the use of some of these life saving interventions. Progress toward CDC's national goal of reducing new HIV infections by 50% by 2005 will likely be as much a function of improvements in resource availability and policies as it will development of new HIV prevention tools.