A Modeling Analysis of Strategies for Allocating Emergency Department HIV and Syphilis Screening Funds in California
- 1Stanford University
Abstract
IntroductionUsing an open enrollment process in 2023, California funded 28 emergency departments (EDs) to implement or expand HIV and syphilis screening programs. Californias 2026 state budget now commits an additional $60 million, over six years, to renew support for this screening. How renewed funds are allocated will determine which communities they reach. This analysis establishes a framework derived from public information to simulate and compare several funding strategies, highlighting the tradeoffs across disease burden, geographic reach, and social vulnerability.
MethodsPublicly available data were used to construct ED-level profiles for the 282 EDs in the 35 California counties with populations exceeding 100,000. Profiles were then linked to corresponding HIV and syphilis burden (z-score), measures of social vulnerability for the surrounding service area , and socioeconomic and demographic characteristics of the population each ED serves. At a 28 ED award scale, allocation strategies (random selection, prior 2023 awardees, federal priority-county targeting, ranking on burden alone, and a composite of burden, vulnerability, and visit volume) were then compared, simulating ED participation across 100,000 Monte Carlo draws at 70% participation. Sensitivity analyses included varied (50% and 90%) participation and a larger (n=64) ED award scale. Analyses were conducted in 2026.
ResultsNo single strategy performed best. Ranking on burden alone reached the highest mean county burden but only 4 of 35 counties, whereas a composite approach reached 8 counties, the highest social vulnerability, and the largest share of patients who identified as Hispanic. Every targeted strategy performed better than both random selection and the prior 2023 awardees on burden but reached fewer counties than either. In sensitivity analyses, the tradeoffs between burden and reach persisted across participation rates and at the 64-ED scale.
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BibTeX
@misc{das2026modeling,
title = {{A Modeling Analysis of Strategies for Allocating Emergency Department HIV and Syphilis Screening Funds in California}},
author = {I. Das and R. Gupta and C. L. Bennett},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.17.26363340},
url = {https://www.medrxiv.org/content/10.64898/2026.09.17.26363340v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - A Modeling Analysis of Strategies for Allocating Emergency Department HIV and Syphilis Screening Funds in California
AU - I. Das
AU - R. Gupta
AU - C. L. Bennett
PY - 2026
DA - 2026/09/17
PB - medRxiv
DO - 10.64898/2026.09.17.26363340
UR - https://www.medrxiv.org/content/10.64898/2026.09.17.26363340v1
AB - IntroductionUsing an open enrollment process in 2023, California funded 28 emergency departments (EDs) to implement or expand HIV and syphilis screening programs. Californias 2026 state budget now commits an additional $60 million, over six years, to renew support for this screening. How renewed funds are allocated will determine which communities they reach. This analysis establishes a framework derived from public information to simulate and compare several funding strategies, highlighting the tradeoffs across disease burden, geographic reach, and social vulnerability. MethodsPublicly available data were used to construct ED-level profiles for the 282 EDs in the 35 California counties with populations exceeding 100,000. Profiles were then linked to corresponding HIV and syphilis burden (z-score), measures of social vulnerability for the surrounding service area , and socioeconomic and demographic characteristics of the population each ED serves. At a 28 ED award scale, allocation strategies (random selection, prior 2023 awardees, federal priority-county targeting, ranking on burden alone, and a composite of burden, vulnerability, and visit volume) were then compared, simulating ED participation across 100,000 Monte Carlo draws at 70% participation. Sensitivity analyses included varied (50% and 90%) participation and a larger (n=64) ED award scale. Analyses were conducted in 2026. ResultsNo single strategy performed best. Ranking on burden alone reached the highest mean county burden but only 4 of 35 counties, whereas a composite approach reached 8 counties, the highest social vulnerability, and the largest share of patients who identified as Hispanic. Every targeted strategy performed better than both random selection and the prior 2023 awardees on burden but reached fewer counties than either. In sensitivity analyses, the tradeoffs between burden and reach persisted across participation rates and at the 64-ED scale.
ER -