Abstract
BackgroundThe study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence.MethodsA cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections.ResultsParallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing.ConclusionsThis study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.
Highlights
The study aimed to estimate the comparative costs per positive diagnosis of previously undetected Human Immunodeficiency Virus (HIV) in three testing regimes: conventional; parallel and point of care (POC) testing
Ambitious 90–90-90 targets have been set to diagnose 90% of all people living with HIV (PLHIV), initiate antiretroviral treatment (ART) for 90% of those diagnosed with HIV infection and to achieve an undetectable viral load in 90% of those on ART [1]
This study aims to analyse the costs of making a HIV positive diagnosis using the three main testing regimes available electively in Queensland, Australia: conventional; parallel; and point of care (POC) testing; in six common testing settings: Private General Practice (GP); Public Sexual Health Clinic (SHC); Community Peer Organisation led General Practice (Community GP); Community Organisation led Volunteer Peer Clinic; Community Organisation led Salaried Peer Clinic; and Private at Home
Summary
The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Ambitious 90–90-90 targets have been set to diagnose 90% of all people living with HIV (PLHIV), initiate antiretroviral treatment (ART) for 90% of those diagnosed with HIV infection and to achieve an undetectable viral load in 90% of those on ART [1]. Transmission of HIV in Australia continues to occur primarily through male-to-male sexual contact (63% of all infections) resulting in a concentrated epidemic among men who have sex with men (MSM) (prevalence of 7.9%) [3]. Needs to explore and consider cost effective means of detecting the last 10%
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