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), where he also serves as the Deputy Dean for Faculty and Research and as the Executive Director of the Max Institute of Healthcare Management (MIHM).

His primary area of research is health care delivery systems. He is interested in investigating the impact of operations decisions on population-level health outcomes. Some of the healthcare contexts that he has studied include the influenza vaccine supply chain and the phenomenon of ambulance diversion in the US, HIV early infant diagnosis networks in sub-Saharan Africa, and formal and informal pathways for tuberculosis (TB) diagnosis in India. He regularly collaborates with international public health funding and implementation agencies such as Bill & Melinda Gates Foundation (BMGF), Clinton Health Access Initiative (CHAI), and PATH for his research. He currently serves as a member of the WHO Strategic and Technical Advisory Group on TB (STAG-TB).

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

Sarang Deo
Sarang Deo