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Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC

BACKGROUND: 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 20...

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Autores principales: Castel, Amanda D., Choi, Sungwoog, Dor, Avi, Skillicorn, Jennifer, Peterson, James, Rocha, Nestor, Kharfen, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605630/
https://www.ncbi.nlm.nih.gov/pubmed/26465771
http://dx.doi.org/10.1371/journal.pone.0139605
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author Castel, Amanda D.
Choi, Sungwoog
Dor, Avi
Skillicorn, Jennifer
Peterson, James
Rocha, Nestor
Kharfen, Michael
author_facet Castel, Amanda D.
Choi, Sungwoog
Dor, Avi
Skillicorn, Jennifer
Peterson, James
Rocha, Nestor
Kharfen, Michael
author_sort Castel, Amanda D.
collection PubMed
description BACKGROUND: 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. METHODS: We 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. RESULTS: Compared 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. CONCLUSIONS: While 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.
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spelling pubmed-46056302015-10-29 Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC Castel, Amanda D. Choi, Sungwoog Dor, Avi Skillicorn, Jennifer Peterson, James Rocha, Nestor Kharfen, Michael PLoS One Research Article BACKGROUND: 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. METHODS: We 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. RESULTS: Compared 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. CONCLUSIONS: While 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. Public Library of Science 2015-10-14 /pmc/articles/PMC4605630/ /pubmed/26465771 http://dx.doi.org/10.1371/journal.pone.0139605 Text en © 2015 Castel et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Castel, Amanda D.
Choi, Sungwoog
Dor, Avi
Skillicorn, Jennifer
Peterson, James
Rocha, Nestor
Kharfen, Michael
Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title_full Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title_fullStr Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title_full_unstemmed Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title_short Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC
title_sort comparing cost-effectiveness of hiv testing strategies: targeted and routine testing in washington, dc
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605630/
https://www.ncbi.nlm.nih.gov/pubmed/26465771
http://dx.doi.org/10.1371/journal.pone.0139605
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