Search PubMed⌕ Search

Biomedical subjects

D R Holtgrave

Publications and source records attributed to D R Holtgrave.

At least 19 recordsLinked to original sources
PubMed1997

Influence of behavioral and social science on public health policymaking.

Public health policies are important guiding principles that serve to shape the well-being of individuals, groups, and society. Behavioral and social scientists can play key influential roles in public health policymaking. The actors and processes involved in setting public health policy are described, and several substantive examples of public health decision making are discussed, emphasizing HIV prevention policy experiences at the Centers for Disease Control and Prevention. The significant influence of behavioral and social science in each of these examples is identified and critiqued. Challenges to further integration of behavioral science and public health policy are identified, and potential solutions are proposed.

Behavioral Sciences↗
PubMed1997

Cost-effectiveness of HIV-prevention skills training for men who have sex with men.

OBJECTIVE: A previous study empirically compared the effects of two HIV-prevention interventions for men who have sex with men: (i) a safer sex lecture, and (ii) the same lecture coupled with a 1.5 h skills-training group session. The skills-training intervention led to a significant increase in condom use at 12-month follow-up, compared with the lecture-only condition. The current study retrospectively assesses the incremental cost-effectiveness of skills training to determine whether it is worth the extra cost to add this component to an HIV-prevention intervention that would otherwise consist of a safer sex lecture only. DESIGN: Standard techniques of incremental cost-utility analysis were employed. METHODS: A societal perspective and a 5% discount rate were used. Cost categories assessed included: staff salary, fringe benefits, quality assurance, session materials, client transportation, client time valuation, and costs shared with other programs. A Bernoulli-process model of HIV transmission was used to estimate the number of HIV infections averted by the skills-training intervention component. For each infection averted, the discounted medical costs and quality-adjusted life years (QALY) saved were estimated. One- and multi-way sensitivity analyses were performed to assess the robustness of base-case results to changes in modeling assumptions. RESULTS: Under base-case assumptions, the incremental cost of the skills training was less than $13,000 (or about $40 per person). The discounted medical costs averted by incrementally preventing HIV infections were over $170,000; more than 21 discounted QALY were saved. The cost per QALY saved was negative, indicating cost-savings. These results are robust to changes in most modeling assumptions. However, the model is moderately sensitive to changes in the per-contact risk of HIV transmission. CONCLUSIONS: Under most reasonable assumptions, the incremental costs of the skills training were outweighed by the medical costs saved. Thus, not only is skills training effective in reducing risky behavior, it is also cost-saving.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Lifetime cost of care for children with human immunodeficiency virus infection.

BACKGROUND: Knowledge of the cost of care for children with HIV infection is necessary to analyze the economic impact of recommendations for universal counseling and voluntary HIV testing of pregnant women. OBJECTIVES: To estimate the total cost of care for children with HIV infection. METHODS: We performed a retrospective cohort study of all 88 children with (n = 29) or at risk for (n = 59) perinatally acquired HIV infection cared for at Children's Hospital of Wisconsin between February 2, 1987, and June 1, 1995. Review of medical records for all 29 children with perinatally acquired HIV infection or AIDS identified: date of HIV diagnosis; date of classification into Category N, A, B or C; date of AIDS diagnosis; and date of death or transfer of care. The time each subject remained in each CDC category was calculated and the Kaplan-Meier product-limit method was used to calculate survival time for all patients in each CDC category. Hospital-based inpatient and outpatient charges per patient per month in each CDC category (N, A, B, C and AIDS) were calculated with information from the hospital financial services database, and lifetime hospital-based inpatient and outpatient charges were estimated as the sum of the charges for each category. From that, total charges were calculated assuming that hospital-based charges were 83% of total charges. RESULTS: Based on a median survival time of 120 months, the mean lifetime charges for hospital-based care for children with HIV infection was $408307 (estimates ranged from $172217 to $498539). If hospital-based care represents 83% of the total charges for care of children with HIV infection, then mean total lifetime charges for care of children with HIV infection were $491936 ($207490 to $600649). CONCLUSIONS: The care of children with HIV infections is expensive. This information may be useful in planning for care programs and for analyzing the economic impact of recommendations for universal counseling and voluntary HIV testing of pregnant women.

Child↗
PubMed1997

The evaluation of HIV counseling-and-testing services: making the most of limited resources.

The evaluation of HIV counseling, testing, referral, and partner notification (CTRPN) services are especially important given the rapid, relevant changes in counseling strategies, public policies, and testing technologies. Here we briefly review the important components of a comprehensive HIV CTRPN evaluation. However, resources for evaluation are usually quite limited, thus making comprehensive evaluations impossible. Yet even with limited resources, meaningful evaluative activities can be performed and some pressing evaluation questions answered. As an illustration, we present a practical evaluation project (conducted with limited resources) that assessed at a systems level the HIV counseling and testing (HIV CT) program in the state of Wisconsin. We describe how some of this evaluative information was utilized by the state's division of health.

AIDS Serodiagnosis↗
PubMed1996

Economic evaluation of HIV prevention programs.

Program managers and policy makers need to balance the costs and benefits of various interventions when planning and evaluating HIV prevention programs. Resources to fund these programs are limited and must be used judiciously to maximize the number of HIV infections averted. Economic evaluation studies of HIV prevention interventions, which we review and critique here, can provide some of the needed information. Special emphasis is given to studies dealing with interventions to reduce or avoid HIV-related risk behaviors. Ninety-three cost-benefit, cost-effectiveness and cost-utility analyses were identified overall. However, only 28 dealt with domestic, behavior change interventions; the remainder focused on screening and testing without prevention counseling, and on care and treatment services. There are compelling demonstrations that behavioral interventions can be cost-effective and even cost-saving. The threshold conditions under which these programs can be considered cost-effective or cost-saving are well defined. However, several important intervention types and multiple key populations have been unstudied. Research in these areas is urgently needed.

Adolescent↗
PubMed1996

Preventing HIV/AIDS among high-risk urban women: the cost-effectiveness of a behavioral group intervention.

OBJECTIVES: A human immunodeficiency virus (HIV) intervention trial for women at high risk for acquired immunodeficiency syndrome and attending an urban clinic was reported previously. The behavioral group intervention was shown to increase condom use behaviors significantly. This study retrospectively assessed the intervention's cost-effectiveness. METHODS: Standard methods of cost and cost-utility analysis were used. RESULTS: The intervention cost was just over $2000 for each quality-adjusted life-year saved; this is favorable compared with other life-saving programs. However, the results are sensitive to changes in some model assumptions. CONCLUSIONS: Under most scenarios, the HIV prevention intervention was cost-effective.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Methodological issues in evaluating HIV prevention community planning.

To be effective, HIV prevention programs should be planned in partnership with affected communities and should be built on a solid scientific foundation. In 1994, the Centers for Disease Control and Prevention (CDC) and its prevention partners implemented HIV prevention community planning to achieve primarily these two objectives. In order to manage the community planning process effectively, extensive evaluation activities were employed at both the grantee and national level. This paper describes the first year evaluation goals and methods in detail. Throughout, reasons for collecting specific types of information and for using particular methodologies are highlighted.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Advances in public health communication.

There have been tremendous advances in recent years in the innovative use of communication to address public health problems. This article outlines the use of communication techniques and technologies to (positively) influence individuals, populations, and organizations for the purpose of promoting conditions conducive to human and environmental health. The approaches described include social marketing, risk communication, and behavioral decision theory, entertainment education, media advocacy, and interactive decision support systems. We also address criticism of these approaches among public health professionals because of perceived discrepancies in their inherent goals and objectives. In conclusion, we call for the rapid diffusion of state-of-the-art public health communication practices into public health service agencies and organizations.

Advertising↗
PubMed1995

Developmental status, gender, age, and self-reported decision-making influences on students' risky and preventive health behaviors.

This study used decision-making theory to analyze the developmental changes associated with children's and adolescents' health behavior. High school and elementary school children completed surveys concerning (1) the extent to which they engage in a variety of preventive and risky health behaviors, and (2) influence sources used in decision making concerning the enactment of these behaviors. Multiple regression analysis revealed that the sources of influence children and adolescents report considering in making health-related decisions change developmentally and as a function of gender. Moreover, within and across age, children's sources of influence with respect to health decision making are dependent on the health domains being considered. The findings are discussed in relation to decision-making theory and the implications for the content and timing of health education initiatives for adolescents.

Adolescent↗
PubMed1994

HIV prevention programs.

Explore the source record for details and available documents.

Centers for Disease Control and Prevention, U.S.↗
PubMed1993

Human immunodeficiency virus counseling, testing, referral, and partner notification services. A cost-benefit analysis.

BACKGROUND: The Centers for Disease Control and Prevention (Atlanta, Ga) annually provides more than +100 million in funding to states, territories, and cities for the provision of human immunodeficiency virus (HIV) counseling, testing, referral, and partner notification (CTRPN) services. Given the size of this expenditure, it is important to consider the net benefits of this program activity. We compared the economic costs and benefits of publicly funded HIV CTRPN services. METHODS: Standard methods for cost-benefit analysis were used. A societal perspective was employed. Major assumptions used in the base-case analysis included the following: (1) without public funding, the HIV CTRPN services would not be provided; (2) for every 100 HIV-seropositive persons identified and reached by CTRPN services, at least 20 new HIV infections are averted; and (3) for every +100 spent on direct and indirect costs of CTRPN services, approximately another +60 is spent on the ancillary costs of alerting people to HIV issues and CTRPN service availability. Sensitivity analyses were performed to explore the robustness of base-case results to these and other changes in model assumptions. RESULTS: Under base-case assumptions, the combined direct, indirect, and ancillary costs of the CTRPN program in 1990 dollars were +188,217,600. At a 6% discount rate, the estimated economic benefits of this expenditure are +3,781,918,000. The resultant benefit-cost ratio is 20.09. Sensitivity analyses showed that the benefit-cost ratio is greater than 1 for all considered cases. CONCLUSIONS: This cost-benefit analysis strongly suggests that publicly funded CTRPN services result in a net economic gain to society.

AIDS Serodiagnosis↗
PubMed1993

Preventive services guidelines for primary care clinicians caring for adults and adolescents infected with the human immunodeficiency virus.

Primary care clinicians caring for persons infected with the human immunodeficiency virus greatly contribute to public health efforts to combat the human immunodeficiency virus/acquired immunodeficiency disease epidemic in the United States. Primary care clinicians can assess the prevention needs of persons infected with the human immunodeficiency virus and ensure that needed prevention services are received.

AIDS Serodiagnosis↗
PubMed1993

Dimensions of risk perception for financial and health risks.

This study of 29 MBA students compares two models of risk perception for both financial and health risk stimuli. The first, inspired by Luce and Weber's Conjoint Expected Risk (CER) model, uses five dimensions: probability of gain, loss and status quo, and expected benefit and harm. The second, inspired by the Slovic et al. psychometric model, employs seven dimensions: voluntariness, dread, control, knowledge, catastrophic potential, novelty, and equity. The CER-type model provided a better fit for most subjects and stimuli. Adding the psychological risk dimensions from the Slovic et al. model explained only modestly more variance. Relationships between the dimensions of the two models are described and the construction of a hybrid model explored.

Accidents↗