Health Policy
Infectious Diseases Research
Division Chief and Associate Professor Bruce R. Schackman, Ph.D., has had a longstanding commitment to HIV/AIDS and hepatitis C treatment and care research, including cost and cost-effectiveness analyses conducted alongside clinical trials and cohort studies; simulation modeling of comparative effectiveness and cost-effectiveness outcomes; and implementation science research regarding budgetary and operational barriers to implementing evidence-based medical interventions. He has also collaborated with Cornell investigators in Haiti in exploring cost-effective methods for diagnosing and treating HIV and syphilis.
Dr. Schackman has an ongoing collaboration with the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) modeling group based at Massachusetts General Hospital in Boston. Working with this group, he has co-authored studies of the lifetime cost of HIV care in the United States (press release; abstract), the cost-effectiveness of expanded HIV screening, and the potential risks and benefits of HIV treatment simplification. Current projects include evaluating the link between HIV prevention and treatment, and the pharmacogenomics of HIV therapy.
With funding from the National Institute on Drug Abuse (NIDA), Dr. Schackman is leading an economic substudy of a randomized clinical trial of on-site rapid HIV testing in drug treatment programs. He will also use simulation modeling to evaluate the cost and cost-effectiveness of providing on-site rapid hepatitis C testing in drug treatment programs, in combination with rapid HIV testing and on its own. In a previous study funded by NIDA, he compared patient and provider assessments of quality-of-life associated with chronic hepatitis C and its treatment. With colleagues, including Ann B. Beeder, M.D., Associate Professor of Public Health and Psychiatry, he also evaluated the outcomes of hepatitis C treatment offers to these patients. He has also evaluated the feasibility of using utility assessment techniques with hepatitis C-infected methadone clinic patients to conduct quality-of-life assessments.
Dr. Schackman conducted an evaluation of racial differences in adherence to HIV medications in a randomized trial conducted by the AIDS Clinical Trials Group of the National Institutes of Health. He also described self-reported patterns of condom use among HIV+ patients, as part of an evaluation of using computer-assisted audio self-interviews in HIV clinical care, and determined the cost of adherence support interventions. The latter two studies were funded by the Health Services and Resources Administration.
A major study conducted in Haiti with the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) evaluated a new rapid syphilis testing of pregnant women. Dr. Schackman and his co-researchers, including Jean W. Pape, M.D., founder and director of GHESKIO and Professor of Medicine, and Daniel W. Fitzgerald, M.D., Assistant Professor of Medicine, found that a new rapid test, when integrated into prenatal care and HIV testing, is more effective than other methods in preventing congenital syphilis cases and stillbirths, and it is also cost-effective (press release; abstract).
