Abstract
ObjectiveIn many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed.DesignWe developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries.MethodsWe estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness.ResultsAnnual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000–£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4–15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained.ConclusionsAnnual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries.
Highlights
Following the recognition that antiretroviral therapy (ART) has both preventive and therapeutic benefits [1], the increased availability of HIV testing programs has enabled persons living with HIV (PLHIV) to receive earlier treatment and care
Of the 6,280 newly diagnosed HIV infections in 2011 in the United Kingdom (UK), 48% were among men who have sex with men (MSM), 2% occurred among people who inject drugs (PWID), and more than half of the remaining heterosexually acquired infections were in Population of UK residents
More than 6,100 people would be diagnosed with HIV in 2013, including 2,700 MSM, 600 PWID, 2,100 men and women from HIV-endemic countries, and 700 other men and women in the population
Summary
Following the recognition that antiretroviral therapy (ART) has both preventive and therapeutic benefits [1], the increased availability of HIV testing programs has enabled persons living with HIV (PLHIV) to receive earlier treatment and care. These programs include ‘‘test and treat’’ [2], ‘‘universal access to HIV services’’ [3] and, for high-prevalence countries, ‘‘universal access to HIV and medical male circumcision services’’ [4]. In 2011, an estimated 96,000 people (95% credible interval 90,800–102,500) were living with HIV in the United Kingdom (UK), with 24% (19%–28%) unaware of their infection status [7]. Of the 6,280 newly diagnosed HIV infections in 2011 in the UK, 48% were among men who have sex with men (MSM), 2% occurred among people who inject drugs (PWID), and more than half of the remaining heterosexually acquired infections were in Variable
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