Estimated Impact of HIV Prevention Budget Cuts for Selected Jurisdictions in California


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Estimated Impact of HIV Prevention Budget Cuts for Selected Jurisdictions in California

  1. 1. Estimated Impact of HIV Prevention Budget Cuts for Selected Jurisdictions in California Feng Lin, PhD; Arielle Lasry, PhD; Annette Ladan, MS; Stephanie Sansom, PhD National HIV Prevention Conference August 14-17, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
  2. 2. Objective□ Develop a tool that state and local health departments can use to measure the impact of HIV prevention budget cuts on their jurisdictions ■ To examine the effect of budget cuts on people living with or at risk for HIV ■ To estimate the impact of the budget cuts on HIV incidence ■ To compare different budget allocation scenarios
  3. 3. Budget and Program Data□ Data on selected jurisdictions were provided by the California State Office of AIDS  Included jurisdictions that did not receive direct funds from CDC  Excluded Los Angeles and San Francisco□ Type of data  Federal and state HIV prevention budgets administered by the Office of AIDS  Number of local agencies that received HIV prevention funds  Number of clients served □ Number of positives who received test results □ Number of unique clients of health education and risk reduction (HERR) services
  4. 4. HIV Prevention Budget Allocated by Prevention Activities Pre-cut scenario 21% ↓ 70% ↓* LA and SF excluded
  5. 5. Testing and Partner Services* LA and SF excluded
  6. 6. Health Education and Risk Reduction (HERR)* LA and SF excluded
  7. 7. Summary of Prevention Services Pre-cut &: FY0910 Reduction (%) FY0506-FY0708Total prevention budget $21,849,923 $5,860,723 $15,989,200 (73)Funded local health jurisdictions 59 15 44 (75)Funded prevention agencies 143 # 36 107 (75)Testing and partner services Budget $4,024,634 $3,160,148 $864,486 (21) Number of tests performed 83,799 52,590 31,209 (37) Number of positives notified of test result 813 465 348 (43)Health education and risk reduction (HERR) Budget $17,825,289 $2,700,575 $15,124,714 (85) Number of unique clients 11,784 3,386 8,398 (71) Number of unique positive clients 2,884 1,100 1,784 (62) Number of unique negative clients 8,900 2,286 6,614 (74)* LA and SF excluded& We took the average values from FY0506 to FY0708 for the pre-cut scenario.# Number of funded local prevention agencies was not available in FY0506 and FY0607.
  8. 8. Methods□ Estimate the number of new infections associated with the budget cuts  Prevention service reduction Number of clients served (pre-cut scenario) – Number of clients served (FY0910)  Estimate HIV transmission: Bernoulli process model □ Testing and partner services □ Health education and risk reduction (HERR) ■ Compare different budget allocation scenarios
  9. 9. Summary of Inputs to Bernoulli ModelParameter Value (Range) SourcePer-act transmission probability Vaginal receptive 0.08% (0.06–0.11%) Boily et al. Lancet Infect Dis 2009; 9(2): 118- 29. Vaginal insertive 0.04% (0.01–0.14%) Anal receptive 1.40% (0.2–2.5%) Baggaley et al. Int J Epidemiol 2010; 39(4): 1048-63. Anal insertive 0.70% (0-1.3%)Condom effectiveness 90% (85–95%) Pinkerton et al. Soc Sci Med 1997; 44(9): 1303-12Annual nb. of sex acts all partners 85 (26-365) Long et al. Ann Intern Med 2010; 153(12): 778-89Annual nb. of sexual partners HET 1.1 (1-20) Long et al. Ann Intern Med 2010; 153(12): 778-89 IDU 3 (1-20) Metsch et al. NHPC2007 MSM 3.5 (1-20) NHBSART effectiveness (reduction in 90% (80-99%) Attia et al. AIDS 2009; 23:1397-1404. (Bunnell et al. Del Romero et al. Donnell et al.)infectivity)Proportion new diagnosis among 60% (40-80%) Hanna et al. JAIDS 2009; 51(5): p. 609-14. ETI datapositives who received test results
  10. 10. Summary of Inputs to Bernoulli Model (cont’)Parameter Value (Range) SourceHIV prevalence in California HET 1.0%(0.75–1.25%) CDC 2001 IDU 5.9%(4–10.2%) Friedman et al. J Urban Health 2005; 82(3): 434-45 MSM 19.1%(12.8–25.35%) Xia et al. JAIDS 2006; 41(2): 238-45Proportion of protected sex acts Undiagnosed positives & those at risk 50% (0-100%) Gary Marks Positive aware w/o particip ating in HERR 75% (50-100%) Gary MarksReduction in UAV for positive aware people 53% (45-60%) Marks et al. JAIDS 2005; 39(4): 446-53.Effect size of HERR for positives 18% (0-40%) Options/Opciones Project,WiLLOW, Healthy Living Project, Healthy Relationships, CLEAREffect size of HERR for negatives 8% (0-20%) INSIGHT,Focus on the Future, Sister to SisterProportion linked to care 69% (66-71%) Marks et al. AIDS 2010; 24(17): 2665-78.Proportion of positive aware in care who 54.5% (40-70%) Marks et al. AIDS 2006; 20: 1447-50.achieve viral load suppression
  11. 11. Estimates of Budget Cut Impact Testing and Health education Total partner services and risk reduction (HERR)Budget cut ($) $ 864,486 $15,124,714 $15,989,200Estimated number of new infectionsassociated with budget cuts HET 1.4 1.9 3.3 IDU 0.3 0.3 0.6 MSM 24.9 37.2 62.1 Total 26.6 39.4 66.0Expected life-time HIV treatment $ 9,760,335 $ 14,476,414 $ 24,236,749cost generatedNumber of new infections per one 30.75 1.92 4.13million dollars cut * LA and SF excluded
  12. 12. Compare Budget Allocation Scenarios Hypothetical pre-cut Actual allocation in allocation scenario FY0910Total prevention budget $5,860,723 (100%) $5,860,723 (100%) Testing and partner services $1,079,512 (18%) $3,160,148 (54%) Health education and risk reduction (HERR) $4,781,211 (82%) $2,700,575 (46%)Number of local health jurisdictions funded 59 15Number of positives notified of test result 159 465Number of unique HERR clients 5,995 3,386 Number of unique positive HERR clients 1,467 1,100 Number of unique negative HERR clients 4,527 2,286Estimated number of infections associated with cuts 88.4 66.0 Testing and partner services 58.9 26.6 HERR for positive 22.2 29.0 HERR for negative 7.2 10.4Expected life-time treatment cost generated $ 32,439,520 $ 24,236,749 * LA and SF excluded
  13. 13. Limitations□ We did not include Los Angeles and San Francisco because data for the two jurisdictions were incomplete.□ Only the first generation of transmissions were captured in the impact estimates.□ We assumed the reductions in prevention services were the same proportionately across risk groups.□ Data inputs for Bernoulli model had varying degrees of uncertainty. These were covered in sensitivity analyses.
  14. 14. Conclusions□ Over $15 million was cut from HIV prevention in FY0910  Testing: we estimated 31,209 fewer tests were performed, 384 fewer positives were notified of their infection  Health education and risk reduction (HERR): 1,784 fewer positive clients and 6,614 fewer negative clients were served□ Impact of budget cuts in FY0910  Estimated 66 new infections were associated with the cuts in one year  The first year new infections were expected to generate $24 million in HIV life-time treatment cost□ Budget allocation in FY0910 appeared to partially reduce the impact of budget cuts  Allocate larger proportion of budget to testing  Fewer new infections would occur * LA and SF excluded
  15. 15. Acknowledgements□ Richard Wolitski, Choi Wan, Jeffrey Brock, Robert Swayzer, Dale Stratford, Dwight Dunbar; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention□ Michelle Roland, Susan Sabatier, Karen Mark, Kevin Sitter, David Webb, Christine Nelson, Karen Doran, Charlene Anderson, Brian Lew, Phillip Morris, Matt Facer, Amy Kile-Puente, Mark Damesyn, Schenelle Flores; Office of AIDS, California Department of Public Health
  16. 16. Questions?For more information please contact: Feng Lin ( for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position ofthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention