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Rochelle Walensky

Rochelle Walensky, MD, MPH is Associate Professor of Medicine at Harvard Medical School, and a practicing Infectious Disease physician at Brigham and Women’s and Massachusetts General Hospitals.  Dr. Walensky has been a member of the CEPAC team since 1998.  Her research interests have focused on HIV/AIDS policy and cost-effective strategies of HIV care in the US and in resource-limited settings. She is nationally recognized for motivating US policy toward the promotion of routine HIV screening. She is the 2008 winner of the Emerging Leader in HIV Research sponsored by the HIV Medical Association and the Infectious Disease Society of America.  Dr. Walensky received her BA from Washington University in St. Louis (1991), her MD from the Johns Hopkins School of Medicine (1995), and her MPH from the Harvard School of Public Health (2001). She trained in Internal Medicine and the Johns Hopkins Hospital (1995-1998) and in Infectious Disease at the MGH/BWH combined fellowship program (1998-2001).  

Development, Calibration and Performance of an HIV Transmission Model Incorporating Natural History and Behavioral Patterns: Application in South Africa.

McCormick AW, Abuelezam NN, Rhode ER, Walensky RP, Becker JE, DiLorenzo MA, Losina E, Freedberg KA, Lipsitch M, Seage GR 3rd.

Understanding HIV transmission dynamics is critical to estimating the potential population-wide impact of HIV prevention and treatment interventions. We developed an individual-based simulation model of the heterosexual HIV epidemic in South Africa a... (more »).

PLoS ONE   2014 May. 9 (5): e98272.  

Research areas: HIV

Projecting the benefits of antiretroviral therapy for HIV prevention: the impact of population mobility and linkage to care

Andrews JR, Wood R, Bekker LG, Middelkoop K, Walensky RP

Recent mathematical models suggested that frequent human immunodeficiency virus (HIV) testing with immediate initiation of antiretroviral therapy (ART) to individuals with a positive test result could profoundly curb transmission. The debate about AR... (more »).

J Infect Dis.   2012 Jul. 206 (4): 543-51  

The cost-effectiveness of routine tuberculosis screening with Xpert MTB/RIF prior to initiation of antiretroviral therapy: a model-based analysis

Andrews JR, Lawn SD, Rusu C, Wood R, Noubary F, Bender MA, Horsburgh CR, Losina E, Freedberg KA, Walensky RP

BACKGROUND: In settings with high tuberculosis (TB) prevalence, 15-30% of HIV-infected individuals initiating antiretroviral therapy (ART) have undiagnosed TB. Such patients are usually screened by symptoms and sputum smear, which have poor sensitivi... (more »).

AIDS   2012 Apr. 26 (8): 987-95  

Research areas: tuberculosis

Risk of progression to active tuberculosis following reinfection with Mycobacterium tuberculosis

Andrews JR, Noubary F, Walensky RP, Cerda R, Losina E, Horsburgh C

BACKGROUND: The risk of progression to active tuberculosis is greatest in the several years following initial infection. The extent to which latent tuberculosis infection reduces the risk of progressive disease following reexposure and reinfection is... (more »).

Clin Infect Dis   2012 Feb. 54 (6): 784-91  

Research areas: tuberculosis

First-line antiretroviral therapy after single-dose nevirapine exposure in South Africa: a cost-effectiveness analysis of the OCTANE trial

Ciaranello AL, Lockman S, Freedberg KA, Hughes M, Chu J, Currier J, Wood R, Holmes CB, Pillay S, Conradie F, McIntyre J, Losina E, Walensky RP, CEPAC-International, OCTANE I

BACKGROUND: The OCTANE trial reports superior outcomes of lopinavir/ritonavir vs. nevirapine-based antiretroviral therapy (ART) among women previously exposed to single-dose nevirapine to prevent mother-to-child HIV transmission. However, lopinavir/r... (more »).

AIDS   2011 Jan. 25 (4): 479-92  

Cost-effectiveness of HIV testing referral strategies among tuberculosis patients in India

Uhler LM, Kumarasamy N, Mayer KH, Saxena A, Losina E, Muniyandi M, Stoler AW, Lu Z, Walensky RP, Flanigan TP, Bender MA, Freedberg KA, Swaminathan S, CEPAC I

BACKGROUND: Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and cost-effe... (more »).

PLoS One   2010 Aug. 5 (9): e12747  

Test and treat DC: forecasting the impact of a comprehensive HIV strategy in Washington DC

Walensky RP, Paltiel AD, Losina E, Morris BL, Scott CA, Rhode ER, Seage GR, Freedberg KA, CEPAC I

BACKGROUND: The United States and international agencies have signaled their commitment to containing the human immunodeficiency virus (HIV) epidemic via early case identification and linkage to antiretroviral therapy (ART) immediately at diagnosis. ... (more »).

Clin Infect Dis   2010 Jul. 51 (4): 392-400  

Does modality of survey administration impact data quality: audio computer assisted self interview (ACASI) versus self-administered pen and paper?

Reichmann WM, Losina E, Seage GR, Arbelaez C, Safren SA, Katz JN, Hetland A, Walensky RP

BACKGROUND: In the context of a randomized controlled trial (RCT) on HIV testing in the emergency department (ED) setting, we evaluated preferences for survey modality and data quality arising from each modality. METHODS: Enrolled participants were o... (more »).

PLoS One   2009 Dec. 5 (1): e8728  

Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: a Côte d'Ivoire appraisal

Losina E, Touré H, Uhler LM, Anglaret X, Paltiel AD, Balestre E, Walensky RP, Messou E, Weinstein MC, Dabis F, Freedberg K, CEPAC I

BACKGROUND: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact... (more »).

PLoS Med   2009 Sep. 6 (10): e1000173  

When to start antiretroviral therapy in resource-limited settings

Walensky RP, Wolf LL, Wood R, Fofana MO, Freedberg KA, Martinson NA, Paltiel AD, Anglaret X, Weinstein MC, Losina E, CEPAC

BACKGROUND: The results of international clinical trials that are assessing when to initiate antiretroviral therapy (ART) will not be available for several years. OBJECTIVE: To inform HIV treatment decisions about the optimal CD4 threshold at which t... (more »).

Ann Intern Med   2009 Jul. 151 (3): 157-66  

HIV pre-exposure prophylaxis (PrEP) in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness

Paltiel AD, Freedberg KA, Scott C, Schackman BR, Losina E, Wang B, Seage G, Sloan C, Sax PE, Walensky RP

Background The combination of tenofovir and emtricitabine (TDF/FTC) shows promise as HIV pre-exposure prophylaxis (PrEP). We sought to forecast clinical, epidemiologic, and economic outcomes of PrEP, taking into account uncertainties regarding effica... (more »).

Clin Infect Dis   2009 Feb. 48 (6): 806–815  

Antiretroviral drugs for preventing mother-to-child transmission of HIV in sub-Saharan Africa: balancing efficacy and infant toxicity

Ciaranello AL, Seage G, Freedberg KA, Weinstein MC, Lockman S, Walensky RP

OBJECTIVE: Antiretroviral drugs can prevent mother-to-child transmission of HIV infection, but in-utero antiretroviral exposure may be associated with neurologic symptoms due to mitochondrial toxicity. We sought to identify the currently recommended ... (more »).

AIDS   2008 Oct. 22 (17): 2359-69  

Scaling up antiretroviral therapy in South Africa: the impact of speed on survival

Walensky RP, Wood R, Weinstein MC, Martinson NA, Losina E, Fofana MO, Goldie SJ, Divi N, Yazdanpanah Y, Wang B, Paltiel AD, Freedberg KA, CEPAC-International I

BACKGROUND: Only 33% of eligible human immunodeficiency virus (HIV)-infected patients in South Africa receive antiretroviral therapy (ART). We sought to estimate the impact of alternative ART scale-up scenarios on patient outcomes from 2007-2012. MET... (more »).

J Infect Dis.   2008 Apr. 197 (9): 1324-32  

The effect of antiretroviral therapy on secondary transmission of HIV among men who have sex with men

McCormick AW, Walensky R, Lipsitch M, Losina E, Hsu H, Weinstein MC, Paltiel AD, Freedberg KA, Seage G

Antiretroviral therapy (ART) reduces human immunodeficiency virus (HIV) RNA load and the probability of transmitting HIV to an HIV-uninfected partner. However, the potential reduction in secondary transmission associated with ART may be offset by the... (more »).

Clinical Infectious Diseases   2007 Mar. 44 (8): 1115-1122  

Expanded HIV screening in the United States: effect on clinical outcomes, HIV transmission, and costs

Paltiel AD, Walensky RP, Schackman BR, Seage G, Weinstein MC, Freedberg KA

Background: An extensive literature supports expanded HIV screening in the United States. However, the question of whom to test and how frequently remains controversial. Objective: To inform the design of HIV screening programs by identifying combina... (more »).

Ann Int Med   2006 Nov. 145 (11): 797-806  

The lifetime cost of HIV care in the United States in the era of highly active antiretroviral therapy

Schackman BR, Gebo KA, Walensky RA, Losina E, Muccio T, Sax PE, Weinstein MC, Seage G, Moore RD, Freedberg KA

Objective:We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards.... (more »).

Med Care   2006 Oct. 44 (11): 990-997  

Impact of opportunistic diseases on chronic mortality in HIV-infected adults in Côte d'Ivoire

Losina E, Anglaret X, Yazdanpanah Y, Wang B, Toure S, Seage G, N'Dri-Yoman T, Walensky RP, Dakoury-Dogbo N, Goldie SJ, Messou E, Weinstein MC, Deuffic-Burban S, Salamon R, Freedberg KA

OBJECTIVE: To estimate incidence rates of opportunistic diseases (ODs) and mortality for patients with and without a history of OD among HIV-infected patients in Côte d'Ivoire. METHODS: Using incidence density analysis, we estimated rates of OD... (more »).

S Afr Med J   2006 May. 96 (6): 526-9  

Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-TB co-infected populations

Cohen T, Lipsitch M, Walensky R, Murray M...

In sub-Saharan Africa, where the emergence of HIV has caused dramatic increases in tuberculosis (TB) case notifications, new strategies for TB control are necessary. Isoniazid preventive therapy (IPT) for HIV-TB coinfected individuals reduces the rea... (more »).

Proceedings of the National Academy of Sciences of the United States of America   2006 Apr. 103 (18): 7042-7047  

Research areas: tuberculosis

Expanded screening for HIV disease in the United States: clinical impact and cost-effectiveness

Paltiel AD, Weinstein MC, Kimmel AD, Seage GR, Losina E, Zhang H, Freedberg KA, Walensky RP

BACKGROUND/OBJECTIVE: Although current CDC guidelines recommend routine HIV counseling, testing, and referral (HIVCTR) in hospitals with > 1% HIV prevalence, an estimated 280,000 Americans remain unaware of their HIV infection. The clinical and ec... (more »).

New Eng J Med   2005 Jun. 352 586-95  

Routine HIV testing: an economic evaluation of current guidelines

Walensky RP, Weinstein MC, Kimmel AD, Seage G, Losina E, Sax PE, Zhang H, Smith HE, Freedberg KA, Paltiel AD

BACKGROUND: The Centers for Disease Control and Prevention guidelines recommend human immunodeficiency virus (HIV) counseling, testing, and referral for all patients in hospitals with an HIV prevalence of >or=1%. The 1% screening threshold has not... (more »).

Am J Med   2005 Feb. 118 (3): 292-300  

A therapeutic HIV vaccine: how good is good enough?

Walensky RP, Paltiel AD, Goldie SJ, Gandhi RT, Weinstein MC, Seage G, Smith HE, Zhang H, Freedberg KA

The goal of a therapeutic HIV vaccine is to attenuate HIV disease progression in those already infected. Our objective was to establish comparative efficacy and cost-effectiveness thresholds at which a therapeutic vaccine would make a valuable contri... (more »).

Vaccine   2004 Aug. 22 (29-30): 4044-53  

Projecting the cost-effectiveness of adherence interventions in persons with human immunodeficiency virus infection

Goldie SJ, Paltiel AD, Weinstein MC, Losina E, Seage G, Kimmel AD, Walensky RP, Sax PE, Freedberg KA

PURPOSE: To explore the cost-effectiveness of interventions to improve adherence to combination antiretroviral therapy in patients with human immunodeficiency virus (HIV) infection. METHODS: A simulation model of HIV infection, incorporating CD4 cell... (more »).

Am J Med   2003 Nov. 115 (8): 632-41  

Treatment for primary HIV infection: projecting outcomes of immediate, interrupted, or delayed therapy

Walensky RP, Goldie SJ, Sax PE, Weinstein MC, Paltiel AD, Kimmel AD, Seage G, Losina E, Zhang H, Islam R, Freedberg KA

With limited data available on the optimal treatment of primary HIV infection, disease modeling can be used to project clinical outcomes and inform decision makers. The authors developed a simulation model to evaluate the clinical outcomes and life e... (more »).

J Acquir Immune Defic Syndr   2002 Aug. 31 (1): 27-37