Planning for HIV screening, testing and care at the Veterans Health Administration
By Sarang Deo, Kumar Rajaram, Sandeep Rath, Uday Karmarkar, Matthew Goetz
Operations Research | March 2015
DOI
doi.org/10.1287/opre.2015.1353
Citation
Deo, Sarang., Rajaram, Kumar., Rath, Sandeep., Karmarkar, Uday., Goetz, Matthew. Planning for HIV screening, testing and care at the Veterans Health Administration Operations Research doi.org/10.1287/opre.2015.1353.
Copyright
Operations Research, 2015
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Abstract
We analyzed the planning problem for HIV screening, testing and care. This problem consists of determining the optimal fraction of patients to be screened in every period as well as the optimum staffing level at each part of the health care system to maximize the total health benefits to the patients measured by Quality-Adjusted Life-Years (QALYs) gained.We modeled this problem as a nonlinear mixed integer programming program comprising of disease progression (the transition of the patients across health states), system dynamics (the flow of patients in different health states across various parts of the health care delivery system), budgetary and capacity constraints.We applied the model to the Greater Los Angeles (GLA) station in the Veterans Health Administration (VHA) system. We found that a Center for Disease Control recommended routine screening policy in which all patients visiting the system are screened for HIV irrespective of risk factors may not be feasible due to budgetary constraints. Consequently, we used the model to develop and evaluate managerially relevant policies within existent capacity and budgetary constraints to improve upon the current risk based screening policy of screening only high risk patients. Our computational analysis showed that the GLA station can achieve substantial increase (20% to 300%) in the QALYs gained by using these policies over risk based screening.The GLA station has already adapted two of these policies that could yield better patient health outcomes over the next few years. In addition, our model insights have influenced the decision making process at this station

Sarang Deo is a Professor of Operations Management at the Indian School of Business (ISB). He also serves as the Executive Director of the ISB’s Max Institute of Healthcare Management, where he provides strategic leadership for ISB's healthcare initiatives through interdisciplinary research, education, and collaboration.

Professor Deo's research focuses on healthcare delivery systems, examining how operational decisions influence population-level health outcomes. His work spans a wide range of healthcare contexts, including influenza vaccine supply chains and ambulance diversion in the United States, HIV early infant diagnosis networks in sub-Saharan Africa, and formal and informal pathways for tuberculosis (TB) diagnosis and treatment in India. His recent research has focused on designing and evaluating healthcare delivery models, with a particular emphasis on digital health and the integration of artificial intelligence into healthcare systems.

He regularly collaborates with leading global health organisations, including the Gates Foundation, the Clinton Health Access Initiative (CHAI), and PATH. He currently serves on the World Health Organization's Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) and the Working Group for Non-Technical Evaluation under the WHO Global Initiative on AI for Health (GI-AI4H).

Prior to joining ISB, Professor Deo was an Assistant Professor at the Kellogg School of Management. He holds a PhD from the UCLA Anderson School of Management, an MBA from the Indian Institute of Management Ahmedabad, and a BTech from the Indian Institute of Technology Bombay. Before entering academia, he worked as a management consultant with Accenture.

Professor Sarang Deo
Sarang Deo