Ronald S. Braithwaite, MD

_{Personal Statement}

I am Professor of Medicine and Population Health, trained in general internal medicine and decision analysis. My background is in decision analytic modeling, evidence synthesis, comparative effectiveness research, and cost-effectiveness analysis. In addition, I am a practicing physician who is fellowship-trained in decision analysis. I am the Chief, Division of Comparative Effectiveness and Decision Sciences, in the Department of Population Health at NYU School of Medicine, which was created to facilitate research projects at the interface of clinical research and the decision sciences. In 2013, I was the President of the Society for Medical Decision Making (SMDM), the leading academic organization to improve decisions in health care. I have extensive experience developing, calibrating, validating, and informing public policy with mathematical models in multiple clinical domains. I have been PI or Co-PI on several National Institutes of Health (NIH)- and Agency for Healthcare Research and Quality (AHRQ)-funded projects and have collaborated with the World Health Organization (WHO) and local and national health departments. I have mentored over 30 pre- and post-doctoral trainees, most of whom have gone on to research careers and successfully competed for funding.

_{Positions and Honors}

Honors:

2013          Elected President of Society of Medical Decision Making (SMDM)

2012          Awarded Distinguished Alumni Award University of Pittsburgh Training Program

2007-10     Robert Wood Johnson Physician Faculty Scholar

2007          Cited for exceptional quality of peer reviews, Annals of Internal Medicine

2006          Yale nominee for Robert Wood Johnson Physician Faculty Scholars Award

2006          Cited for exceptional quality of peer reviews, Annals of Internal Medicine

2003          Finalist, Hamolsky Award, Society for General Internal Medicine

2002          Best Short Course, 24th Annual Meeting, Society for Medical Decision Making

2002          Finalist, Hamolsky Award, Society for General Internal Medicine

2000          Lee B. Lusted Prize, Best Abstract, Society for Medical Decision Making

1993          MD with Distinction in Research Award, State University of NY at Stony Brook

_{Contribution to Science}

1. Estimating the Impact of Alcohol on HIV Pandemic. Our team has developed a validated HIV computer simulation model which we have used to compare alternative monitoring strategies for HIV infected individuals who have started on ART. Our work is distinct in that it systematically compared an exhaustive set of plausible monitoring possibilities, including many that were feasible yet not under active programmatic consideration, and it linked impact on HIV progression with impact on HIV transmission. In addition, it compared the value against simultaneously resource constrained interventions that were programmatic priorities, rather than against arbitrary thresholds (as is the more common practice). 

• Braithwaite RS, Nucifora KA, Toohey C, et al. How do different eligibility guidelines for antiretroviral therapy affect the cost-effectiveness of routine viral load testing in sub-Saharan Africa? AIDS. 2014;28 Suppl 1:S73-83. PMCID: PMC4089870
• Keebler D, Revill P, Braithwaite RS, et al. Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models. Lancet Global Health. 2014;2(1):e35-43. PMCID: PMC4404633
• Khademi A, Braithwaite RS, Saure D, Schaefer AJ, Nucifora K, Roberts MS. Should expectations about the rate of new antiretroviral drug development impact the timing of HIV treatment initiation and expectations about treatment benefits? PLoS One. 2014;9(6):e98354. PMCID: PMC4070901
• Kessler J, Nucifora K, Li L, Uhler L, Braithwaite RS. Impact and Cost-Effectiveness of Hypothetical Strategies to Enhance Retention in Care within HIV Treatment Programs in East Africa. Value Health. 2015;18(8):946-955. PMCID: PMC4696404

      2.Averting the Most HIV Infections with Limited Resources. Previous research has shown that alcohol consumption is associated with decreased antiretroviral adherence, and decreased adherence results in poorer outcomes. However the magnitude of alcohol’s  impact on survival is unknown. Using clinical data             we incorporated data into our HIV simulation model.

• Braithwaite RS, Nucifora KA, Kessler J, et al. Impact of Interventions Targeting Unhealthy Alcohol Use in Kenya on HIV Transmission and AIDS-Related Deaths. Alcohol Clin Exp Res. 2014;38(4):1059-1067.
• Braithwaite RS, Nucifora KA, Kessler J, et al. How inexpensive does an alcohol intervention in Kenya need to be in order to deliver favorable value by reducing HIV-related morbidity and mortality? J. Acquir. Immune Defic. Syndr. 2014;66(2):e54-58.
• Braithwaite RS, Bryant K. Influence of Alcohol Consumption on Adherence to and Toxicity of Antiretroviral Therapy and Survival. Alcohol Research & Health. 2010;33(3):280-287. PMCID: PMC3860503.
• Braithwaite RS, Conigliaro J, Roberts MS, et al. Estimating the impact of alcohol consumption on survival for HIV+ individuals. AIDS care. 2007;19(4):459-466.

       3.Optimize quality and value in healthcare. Given the importance of working within limited resources, my research has focused on optimizing quality and value in healthcare in Sub-Saharan Africa and other developing countries through the use of mathematical modeling. This body of work includes research                        evaluating the cost, effectiveness, and value of different strategies for antiretroviral monitoring, eligibility guidelines for antiretroviral therapy, enhancing retention-in-care, and interventions targeting unhealthy drug use. This research is currently being used to inform the next generation of WHO guidelines.

• Braithwaite RS, Nucifora KA, Toohey C, Kessler J, Uhler LM, Mentor SM, Keebler D, Hallett T. How do different eligibility guidelines for antiretroviral therapy affect the cost-effectiveness of routine viral load testing in sub-Saharan Africa? AIDS. 2014 Jan; 28 Suppl 1:S73-83. PMID: 24468949
• Keebler D, Revill P, Braithwaite RS, et al. Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models. Lancet Global Health. 2014;2(1):e35-43. PMID:25104633
• Kessler J, Braithwaite RS. Modeling the cost-effectiveness of HIV treatment: how to buy the most 'health' when resources are limited. Current opinion in HIV and AIDS. 2013; 8(6):544-549. PMID: 24100874
• Braithwaite RS, Rosen AB. Linking cost sharing to value: an unrivaled yet unrealized public health opportunity. Annals of internal medicine. 2007;146(8):602-605.

      4.Making evidence assumptions transparent and development of objective decision rules. My early work focused on the development of objective rules for decision making based on model results, and helping decision makers know when to “trust the model” because of concerns about biased inputs. In decision making, providing objective rules helps guide providers and payers to know when it is most efficient and effective to adapt clinical guidelines. This research has the potential to both improve healthcare quality and to reduce unnecessary resource expenditures, as well as to increase the use of modeling in the policy arena.

• Braithwaite RS, Meltzer DO, King JT, Jr., Leslie D, Roberts MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Medical care. 2008;46(4):349-356. PMID:18362813
• Braithwaite RS, Roberts MS, Justice AC. Incorporating quality of evidence into decision analytic modeling. Ann Intern Med. 2007;146(2):133-141. PMID: 17227937
• Braithwaite RS, Roberts MS, Justice AC. Incorporating Quality of Evidence into Decision Analytic Modeling. Annals of internal medicine. 2007;146(2):133-141.
• Braithwaite RS, Meltzer DO, King JT, Jr., Leslie D, Roberts MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Medical care. 2008;46(4):349-356.

_{Research Support}

Ongoing Research Support

2U01AA020799-06 (Braithwaite) NIH/NIAID -  09/06/11-08/31/2021       Consortium to Improve Outcomes in HIV/AIDS, Alcohol, Aging & Multi-substance use (COMpAAAS) Our study creates an interactive, web-based simulation model of HIV transmission that can help decision makers prioritize which intervention designs are most effect by tailoring results to patients and feasibility constraints. Role: Principal Investigator     1R01AA024706-01A1 (Braithwaite) NIH/NIAAA - 09/15/2016 – 06/30/2021 Should Screening and Treatment Strategies for Unhealthy Alcohol Misuse in HIV Infected Persons Vary with Smoking, Depression, and Substance Abuse? This study aims to inform guideline development for screening and treatment of unhealthy alcohol use, substance use, smoking and depression in HIV-infected persons. The target population is HIV-infected individuals in care at integrated health systems in regions with high HIV incidence. Role: Principal Investigator     4U24AA022007-05 (Braithwaite) NIH/NIAAA - 09/15/2012 – 08/31/2018 The Operations Research Collaboration for Alcohol Abuse and AIDS: ORCAAA The goal of the study is to develop an Implementation Science Resource Core to support the research efforts of several CHARRT consortia, building upon existing infrastructure within these consortia. Role: Principal Investigator     R25EB020389-02 (Braithwaite, Recht) NIH/NIBIB - 12/01/2015 – 11/30/2018 Discovering the Value of Imaging: A Collaborative Training Program in Biomedical Big Data and Comparative Effectiveness Research for the Field of Radiology This study addresses this lack of evidence-based use of imaging by developing a collaborative training program in comparative effectiveness research (CER) and biomedical big data that will be accessible to a large number of imagers and imaging trainees. Role: Co-Principal Investigator     5R01DA040480-02 (Gwadz, Collins) NIDA - 04/01/2016 – 03/31/2021 Using MOST to Optimize an HIV Care Continuum Intervention for Vulnerable Populations MOST is a framework for building optimized behavioral interventions.  In the proposed project, we will use an innovative, highly efficient fractional factorial experimental design to test the efficacy of five distinct intervention components. Role: Co-Investigator     1U01AA021990 (Schensul, Saggurti, Schensul) NIH/NIAAA - 02/15/14 – 01/31/19       Alcohol and ART Adherence: Assessment, Intervention and Modeling in India This study seeks to provide an understanding of current ART implementation and alcohol and other challenges to ART adherence; identify and test multilevel interventions that can reduce alcohol consumption as a central factor in enhancing adherence; and develop predictive models for use in India and elsewhere that provides a basis for allocating intervention resources in the most cost-effective way to maximize adherence, reduce years and quality of life lost to HIV, and minimize HIV transmission. Role: Co-Investigator     1R01MH101028-A1 (Nash, Irvine) NIH/NIMH - 09/26/2013 – 08/31/2018       HIV care coordination: comparative effectiveness, outcome determinants and costs The goal of the study is to 1) assess the effectiveness of the intervention by comparing primary outcomes among participants with those of similar PLWH in HIV care who do not receive the intervention; 2) among those who enroll in the intervention, identify individual and program-level determinants of care engagement and VL suppression up to 36 months following enrollment; and 3) assess the cost-effectiveness  of the relative to usual care outside the, considering downstream cost-savings and individual and public health benefits due to improved VL suppression and HIV infections averted. Role: Co-Investigator     1R01DA044037-01A1 (Khan) NIH/NIDA - 07/01/2017 – 04/30/2022        Stop-and-Frisk, Arrest and Incarceration and STI/HIV Risk in Minority MSM This study addresses critical gaps across the fields of criminal justice, addictions, and infectious disease by elucidating the role of multiple levels of criminal justice involvement (CJI), from aggressive policing (“stop-and- frisk”) to arrest and incarceration, in the STI/HIV risk of black, Hispanic, and other minority men who have sex with men (MSM). Role: Co-Investigator     IIR (VA) (Makarov) - 03/01/2018 – 02/28/2023 Health Services Research and Development Service (HSR&D), Veterans Affairs A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging This study will describe and analyze the implementation of a theory-based, multi-level (individual, facility, system) behavioral intervention, leveraging the integrated, VHA healthcare delivery system to improve appropriate utilization of prostate cancer imaging. We will implement and evaluate provider experience and cost of this implementation project. Role: Co-Investigator

 

Completed Research Support

R01CA173754 (Crothers, Braithwaite, Wisnivesky) NIH/PEPFAR - 04/10/2013 – 03/31/2018 Benefits and Harms of Lung Cancer Screening in HIV Infection This project developed a mathematical model that estimates the potential benefits of screening, identifies the appropriate candidates for screening, and determines the best screening regimen for HIV+ individuals. Role: Co-Principal Investigator     5P30DA011041-18 (Braithwaite, Shelley) NIH/NIDA 04/15/2013 – 3/31/2018                  An Interdisciplinary Approach to HIV and Other Infectious Diseases The Center provides a research infrastructure to enhance productivity and synergy across investigators working to meet the goals of the National HIV/AIDS Strategy. It also enhances the research translation process so that findings are more rapidly brought from discovery to public health impact. Role: Co-Principal Investigator     1R01DA034637 (Hagan) NIH - 07/01/2013 – 04/30/2017       Addressing hepatitis C and hepatocellular carcinoma: The current and future epidemics The goal of this project is to use simulations to determine the combination of effective interventions for particular budget and epidemiologic scenarios that a) minimize HCV transmission, b) eradicate persistent HCV infections, c) prevent the most HCC, and d) maximize life expectancy and quality-adjusted life expectancy. Role: Co-Investigator     R01AI100059 (El-Sadr) NIH/PEPFAR - 06/15/2012 – 05/31/2016 A combination intervention strategy for linkage and retention: Swaziland This project is focused on the issue of linkage of HIV positive patients to care and their retention in care. Role: Co-Investigator     1R01AI099970 (Braithwaite) NIH/NIAID  - 05/15/2012 – 04/30/2016 Implementation Science to optimize HIV prevention in East Africa PEPFAR programs The goal of this project is to identify more efficient ways to increase the amount of health benefits from PEPFAR resources with a specific emphasis on retention-in-care. Role: Principal Investigator     1R01DA032080 (Kurth) NIH/NIDA - 07/15/2011 – 04/30/2016       Test and Linkage to Care (TLC_IDU Kenya) The goal of this study is to reduce HIV transmission due to injecting drug use (IDU) in Kenya. This goal will be accomplished by leveraging a first-ever needle and syringe exchange program (NSP) platform that the Government of Kenya (GoK) will launch. Role: Co-Investigator     R01DA032083 (Gwadz) NIH/NIDA - 07/15/2011 – 04/30/2016 Peer Driven Intervention to Seek, Test, & Treat Heterosexuals at High Risk for HIV This five-year study aims to evaluate the efficacy of a brief, scalable, peer driven intervention to seek and test heterosexuals at high risk for HIV, and link them to care with high retention if found HIV infected. It will also examine the cost effectiveness of the intervention and compare the efficiency and costs of two sampling methods for the population: respondent driven sampling and venue based sampling. Role: Co-Investigator