Screening for acute HIV infection in community-based settings: Cost-effectiveness and impact on transmissions

Martin Hoenigl, Antoine Chaillon, Sanjay R Mehta, Davey M Smith, Joshua Graff-Zivin and Susan J Little
Authors registered in the RePEc Author Service: Joshua Graff Zivin

University of California at San Diego, Economics Working Paper Series from Department of Economics, UC San Diego

Abstract: Objectives To determine cost-effectiveness of three community-based acute HIV infection (AHI) testing algorithms compared to HIV antibody testing alone by focusing on the potential of averting new infections occurring within a one-year time horizon among men who have sex with men (MSM). Methods Data sources for model parameters included actual cost and prevalence data derived from a community-based AHI screening program in San Diego, and published studies. Main outcome measure was costs per infection averted (IA). The lower end of the cost range of discounted lifetime costs of an HIV infection (i.e. $236,948) was used for defining cost-effectiveness. Results The most sensitive algorithm for AHI detection, which was based on HIV nucleic acid amplification testing, was estimated to prevent between 5 and 45 transmissions, with simulated costs per infection averted between $965 and $141,256 when compared to HIV antibody testing alone. Conclusion AHI testing was cost-effective in preventing new HIV infections among at risk MSM in San Diego, and also among other MSM populations with similar HIV prevalence but lower proportions of AHI diagnoses. These results indicate that community-based AHI testing among MSM in the United States can pay for itself over the long run.

Keywords: Medical Microbiology; Biomedical and Clinical Sciences; Clinical Sciences; Infectious Diseases; Clinical Research; Prevention; Sexually Transmitted Infections; Comparative Effectiveness Research; HIV/AIDS; Cost Effectiveness Research; Sexual and Gender Minorities (SGM/LGBT*); Health Services; Infection; Good Health and Well Being; Algorithms; California; Cost-Benefit Analysis; Early Diagnosis; HIV Infections; Health Promotion; Homosexuality; Male; Humans; Male; Monte Carlo Method; Preventive Health Services; Risk Assessment; Safe Sex; Sensitivity and Specificity; HIV transmission; Acute HIV; MSM; Testing; Cost analysis; NAT; Infection averted; Microbiology; Clinical sciences (search for similar items in EconPapers)
Date: 2016-11-01
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