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Papers by DANIEL ENRIQUE CASALIGLIA GORDON
BACKGROUND: Momentum around ending the HIV epidemic has increased in recent years. In the absence... more BACKGROUND: Momentum around ending the HIV epidemic has increased in recent years. In the absence of a vaccine or cure, the New York State (NYS) discussion of “End of AIDS” has focused on markedly decreasing new HIV transmissions and decreasing progression to AIDS among those already infected. Key epidemiologic measures derived from HIV surveillance data were used to construct a scenario that could represent the “End of AIDS” in NYS. METHODS: The “End of AIDS” indicator selected for this project was the achievement of a transmission rate of less than 0.5 new infections per 100 living infected persons by 2020. New infections in 2011 were estimated using CDC incidence methodology and were projected to decline exponentially to the specified 2020 target. Deaths among persons living with diagnosed HIV and new HIV diagnoses over the period 2013-2020 were projected linearly using NYS HIV surveillance data from 2007-2011. Persons living with HIV infection in 2011, both total and diagnosed, ...
Journal of public health management and practice : JPHMP, Jan 16, 2015
New York health care providers have experienced declining percentages of positive human immunodef... more New York health care providers have experienced declining percentages of positive human immunodeficiency virus (HIV) tests among patients. Furthermore, observed positivity rates are lower than expected on the basis of the national estimate that one-fifth of HIV-infected residents are unaware of their infection. We used mathematical modeling to evaluate whether this decline could be a result of declining numbers of HIV-infected persons who are unaware of their infection, a measure that is impossible to measure directly. A stock-and-flow mathematical model of HIV incidence, testing, and diagnosis was developed. The model includes stocks for uninfected, infected and unaware (in 4 disease stages), and diagnosed individuals. Inputs came from published literature and time series (2006-2009) for estimated new infections, newly diagnosed HIV cases, living diagnosed cases, mortality, and diagnosis rates in New York. Primary model outcomes were the percentage of HIV-infected persons unaware o...
Journal of Policy Analysis and Management, 2014
A recent New York law requires medical providers to offer HIV tests as part of routine care. We d... more A recent New York law requires medical providers to offer HIV tests as part of routine care. We developed a system dynamics simulation model of the HIV testing and care system to help administrators understand the law's potential epidemic impact, resource needs, strategies to improve implementation, and appropriate outcome indicators for future policy evaluations once postlaw data become available. Policy modeling allowed us to synthesize information from numerous sources including quantitative administrative data sets and practitioners' content expertise, structure the information to be viewed both numerically and visually, and organize consensus for decisionmaking purposes. This case illustrates how policy modeling can provide an integrated framework for administrators to examine policy problems in complex systems, particularly when data time lags limit pre-post comparisons and key outcomes cannot be measured directly.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
Background: A 2010 New York law requires that patients aged 13-64 years be offered HIV testing in... more Background: A 2010 New York law requires that patients aged 13-64 years be offered HIV testing in routine medical care settings. Past studies report the clinical outcomes, cost-effectiveness, and budget impact of expanded HIV testing nationally and within clinics but have not examined how state policies affect resource needs and epidemic outcomes. Methods: A system dynamics model of HIV testing and care was developed, where disease progression and transmission differ by awareness of HIV status, engagement in care, and disease stage. Data sources include HIV surveillance, Medicaid claims, and literature. The model projected how alternate implementation scenarios would change new infections, diagnoses, linkage to care, and living HIV cases over 10 years. Results: Without the law, the model projects declining new infections, newly diagnosed cases, individuals newly linked to care, and fraction of undiagnosed cases (reductions of 62.8%, 59.7%, 54.1%, and 57.8%) and a slight increase in living diagnosed cases and individuals in care (2.2% and 6.1%). The law will further reduce new infections, diagnosed AIDS cases, and the fraction undiagnosed and initially increase and then decrease newly diagnosed cases. Outcomes were consistent across scenarios with different testing offer frequencies and implementation times but differed according to the level of implementation. Conclusions: A mandatory offer of HIV testing may increase diagnoses and avert infections but will not eliminate the epidemic. Despite declines in new infections, previously diagnosed cases will continue to need access to antiretroviral therapy, highlighting the importance of continued funding for HIV care.
Journal of acquired immune deficiency syndromes (1999), 2015
Prompt entry to care after HIV diagnosis benefits the infected individual and reduces the likelih... more Prompt entry to care after HIV diagnosis benefits the infected individual and reduces the likelihood of further transmission of the virus. The New York State HIV Testing Law of 2010 requires diagnosing providers to refer persons newly diagnosed with HIV to follow-up medical care. This study used routinely collected HIV-related laboratory data from the New York State HIV surveillance system to assess whether the fraction of newly diagnosed cases entering care within 90 days of diagnosis increased after the implementation of the law. Laboratory data on 23,302 newly diagnosed cases showed that entry to care within 90 days rose steadily from 72.0% in 2007 to 85.4% in 2012. The rise was observed across all race/ethnic groups, ages, transmission risk groups, sexes, and regions of residence. Logistic regression analyses of entry to care pre-law and post-law, controlling for demographic characteristics, transmission risk, and geographic area, indicate that percentage of newly diagnosed cases entering care within 90 days grew more rapidly in the post-law period. This is consistent with a positive effect of the law on entry to care.
Paediatric and Perinatal Epidemiology, 2011
Decreasing mother-to-child transmission is changing the population of children and adolescents wi... more Decreasing mother-to-child transmission is changing the population of children and adolescents with HIV. This project used recent epidemiological data to develop shortterm projections of children and adolescents living with diagnosed HIV infection in New York State. A population simulation model was created to project prevalence of diagnosed HIV cases aged 0-19 years by age, sex, race/ethnicity and risk for years 2007-2014. Using 2006 data as the baseline population and 2001-2006 diagnosis and death data, annual diagnoses and deaths were calculated for each age/sex/race/risk category and known cases were 'aged' into the next year. The model produced annual estimates until 2014. The model predicts a decline in the number of persons aged 0-19 years living with diagnosed HIV in New York from 2810 in 2006 to 1431 in 2014, a net decrease of 49%. Living cases with paediatric risk continue to decrease. Cases aged 13-19 with non-paediatric risk increase slowly, leading to a shift in the risk composition of the population. The dominant effect seen in the model is the ageing out of perinatally infected children born before measures to prevent mother-to-child transmission were broadly implemented in the mid-to late 1990s. Changing trends in the young HIVinfected population should be considered in developing public health programmes for HIV prevention and care in New York State for the coming years.
BACKGROUND: Momentum around ending the HIV epidemic has increased in recent years. In the absence... more BACKGROUND: Momentum around ending the HIV epidemic has increased in recent years. In the absence of a vaccine or cure, the New York State (NYS) discussion of “End of AIDS” has focused on markedly decreasing new HIV transmissions and decreasing progression to AIDS among those already infected. Key epidemiologic measures derived from HIV surveillance data were used to construct a scenario that could represent the “End of AIDS” in NYS. METHODS: The “End of AIDS” indicator selected for this project was the achievement of a transmission rate of less than 0.5 new infections per 100 living infected persons by 2020. New infections in 2011 were estimated using CDC incidence methodology and were projected to decline exponentially to the specified 2020 target. Deaths among persons living with diagnosed HIV and new HIV diagnoses over the period 2013-2020 were projected linearly using NYS HIV surveillance data from 2007-2011. Persons living with HIV infection in 2011, both total and diagnosed, ...
Journal of public health management and practice : JPHMP, Jan 16, 2015
New York health care providers have experienced declining percentages of positive human immunodef... more New York health care providers have experienced declining percentages of positive human immunodeficiency virus (HIV) tests among patients. Furthermore, observed positivity rates are lower than expected on the basis of the national estimate that one-fifth of HIV-infected residents are unaware of their infection. We used mathematical modeling to evaluate whether this decline could be a result of declining numbers of HIV-infected persons who are unaware of their infection, a measure that is impossible to measure directly. A stock-and-flow mathematical model of HIV incidence, testing, and diagnosis was developed. The model includes stocks for uninfected, infected and unaware (in 4 disease stages), and diagnosed individuals. Inputs came from published literature and time series (2006-2009) for estimated new infections, newly diagnosed HIV cases, living diagnosed cases, mortality, and diagnosis rates in New York. Primary model outcomes were the percentage of HIV-infected persons unaware o...
Journal of Policy Analysis and Management, 2014
A recent New York law requires medical providers to offer HIV tests as part of routine care. We d... more A recent New York law requires medical providers to offer HIV tests as part of routine care. We developed a system dynamics simulation model of the HIV testing and care system to help administrators understand the law's potential epidemic impact, resource needs, strategies to improve implementation, and appropriate outcome indicators for future policy evaluations once postlaw data become available. Policy modeling allowed us to synthesize information from numerous sources including quantitative administrative data sets and practitioners' content expertise, structure the information to be viewed both numerically and visually, and organize consensus for decisionmaking purposes. This case illustrates how policy modeling can provide an integrated framework for administrators to examine policy problems in complex systems, particularly when data time lags limit pre-post comparisons and key outcomes cannot be measured directly.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
Background: A 2010 New York law requires that patients aged 13-64 years be offered HIV testing in... more Background: A 2010 New York law requires that patients aged 13-64 years be offered HIV testing in routine medical care settings. Past studies report the clinical outcomes, cost-effectiveness, and budget impact of expanded HIV testing nationally and within clinics but have not examined how state policies affect resource needs and epidemic outcomes. Methods: A system dynamics model of HIV testing and care was developed, where disease progression and transmission differ by awareness of HIV status, engagement in care, and disease stage. Data sources include HIV surveillance, Medicaid claims, and literature. The model projected how alternate implementation scenarios would change new infections, diagnoses, linkage to care, and living HIV cases over 10 years. Results: Without the law, the model projects declining new infections, newly diagnosed cases, individuals newly linked to care, and fraction of undiagnosed cases (reductions of 62.8%, 59.7%, 54.1%, and 57.8%) and a slight increase in living diagnosed cases and individuals in care (2.2% and 6.1%). The law will further reduce new infections, diagnosed AIDS cases, and the fraction undiagnosed and initially increase and then decrease newly diagnosed cases. Outcomes were consistent across scenarios with different testing offer frequencies and implementation times but differed according to the level of implementation. Conclusions: A mandatory offer of HIV testing may increase diagnoses and avert infections but will not eliminate the epidemic. Despite declines in new infections, previously diagnosed cases will continue to need access to antiretroviral therapy, highlighting the importance of continued funding for HIV care.
Journal of acquired immune deficiency syndromes (1999), 2015
Prompt entry to care after HIV diagnosis benefits the infected individual and reduces the likelih... more Prompt entry to care after HIV diagnosis benefits the infected individual and reduces the likelihood of further transmission of the virus. The New York State HIV Testing Law of 2010 requires diagnosing providers to refer persons newly diagnosed with HIV to follow-up medical care. This study used routinely collected HIV-related laboratory data from the New York State HIV surveillance system to assess whether the fraction of newly diagnosed cases entering care within 90 days of diagnosis increased after the implementation of the law. Laboratory data on 23,302 newly diagnosed cases showed that entry to care within 90 days rose steadily from 72.0% in 2007 to 85.4% in 2012. The rise was observed across all race/ethnic groups, ages, transmission risk groups, sexes, and regions of residence. Logistic regression analyses of entry to care pre-law and post-law, controlling for demographic characteristics, transmission risk, and geographic area, indicate that percentage of newly diagnosed cases entering care within 90 days grew more rapidly in the post-law period. This is consistent with a positive effect of the law on entry to care.
Paediatric and Perinatal Epidemiology, 2011
Decreasing mother-to-child transmission is changing the population of children and adolescents wi... more Decreasing mother-to-child transmission is changing the population of children and adolescents with HIV. This project used recent epidemiological data to develop shortterm projections of children and adolescents living with diagnosed HIV infection in New York State. A population simulation model was created to project prevalence of diagnosed HIV cases aged 0-19 years by age, sex, race/ethnicity and risk for years 2007-2014. Using 2006 data as the baseline population and 2001-2006 diagnosis and death data, annual diagnoses and deaths were calculated for each age/sex/race/risk category and known cases were 'aged' into the next year. The model produced annual estimates until 2014. The model predicts a decline in the number of persons aged 0-19 years living with diagnosed HIV in New York from 2810 in 2006 to 1431 in 2014, a net decrease of 49%. Living cases with paediatric risk continue to decrease. Cases aged 13-19 with non-paediatric risk increase slowly, leading to a shift in the risk composition of the population. The dominant effect seen in the model is the ageing out of perinatally infected children born before measures to prevent mother-to-child transmission were broadly implemented in the mid-to late 1990s. Changing trends in the young HIVinfected population should be considered in developing public health programmes for HIV prevention and care in New York State for the coming years.