Abstract
BackgroundRoutine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.MethodsWe sought to evaluate the cost effectiveness of the District of Columbia (DC) Department of Health’s routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations); collected testing and labor costs; and calculated effectiveness measures including cost per new diagnosis and cost per averted transmission.ResultsCompared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%). Routine testing averted 34.30 transmissions per year compared to targeted testing at 17.78. The cost per new diagnosis was lower for targeted testing ($2,467 vs. $7,753 per new diagnosis) as was the cost per transmission averted ($33,160 vs. $104,205). When stratified by testing site, both testing approaches were most cost effective in averting new transmissions when conducted by community based organizations ($25,037 routine; $33,123 targeted) compared to hospitals or clinics.ConclusionsWhile routine testing identified more newly diagnosed infections and averted more infections than targeted testing, targeted testing is more cost effective per diagnosis and per transmission averted overall. Given the high HIV prevalence in DC, the DC Department of Health’s implementation strategy should continue to encourage routine testing implementation with emphasis on a combined testing strategy among community-based organizations.
Highlights
Routine HIV testing is an essential tool to identify undiagnosed HIV infections, link people to care and treatment, reduce HIV-related morbidity and mortality, and prevent new infections
Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections
Compared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%)
Summary
Routine HIV testing is an essential tool to identify undiagnosed HIV infections, link people to care and treatment, reduce HIV-related morbidity and mortality, and prevent new infections. In 2006 the Centers for Disease Control and Prevention (CDC) issued revised recommendations on the implementation of routine HIV testing in health-care settings [5]. The recommendations called for routine opt-out HIV testing to be offered in all health-care settings, including substance use treatment settings, correction healthcare facilities, emergency and urgent care clinics, primary care settings, and all public health and community health-care clinics [5]. Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006
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