Modeling the Impact of Antiretroviral Use in Developing Countries

Abstract:  Ideally, evaluations of strategies related to the use of antiretroviral agents would use large-scale randomized trials with HIV-related mortality as the primary endpoint. In reality, however, such studies are rarely conducted, given the long follow-up needed and the substantial costs. Furthermore, people currently living with HIV/AIDS need treatment now, not at the conclusion of long-term prospective trials. Model-bas ed methods are a powerful and practical means of performing formal comparisons of health interventions when the ideal is not possible. Model-based analyses synthesize data from multiple sources, permitting decision makers to understand the likely impact of different strategies and to set priorities for clinical trials. Models also offer a practical framework for managing uncertainty via (1) sensitivity analysis (i.e., sensitivity of the model's outputs to variation in the model's parameters that are either variable or estimated with uncertainty) and (2) analysis of different scenarios (which can represent different settings and/or different levels of optimism in the values of the model's parameters). Finally, models permit analyses that extrapolate beyond the limitations of a trial's time constraints, geographic setting, and study population. Citation: Bertozzi SM, Bautista-Arredondo S (2006) Modeling the Impact of Antiretroviral Use in Developing Countries. PLoS Med 3(4): e148. doi:10.1371/journal. pmed.0030148