Comparing cost-effectiveness of HIV testing strategies: Targeted and routine testing in Washington, DC

Amanda D. Castel, Sungwoog Choi, Avi Dor, Jennifer Skillicorn, James Peterson, Nestor Rocha, Michael Kharfen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere0139605
JournalPloS one
Volume10
Issue number10
DOIs
StatePublished - Oct 14 2015

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District of Columbia
cost effectiveness
Cost effectiveness
Cost-Benefit Analysis
HIV
Costs and Cost Analysis
Testing
testing
Organizations
Infection
Health
Costs
infection

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Castel, A. D., Choi, S., Dor, A., Skillicorn, J., Peterson, J., Rocha, N., & Kharfen, M. (2015). Comparing cost-effectiveness of HIV testing strategies: Targeted and routine testing in Washington, DC. PloS one, 10(10), [e0139605]. https://doi.org/10.1371/journal.pone.0139605
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. In: PloS one. 2015 ; Vol. 10, No. 10.
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Castel, AD, Choi, S, Dor, A, Skillicorn, J, Peterson, J, Rocha, N & Kharfen, M 2015, 'Comparing cost-effectiveness of HIV testing strategies: Targeted and routine testing in Washington, DC', PloS one, vol. 10, no. 10, e0139605. https://doi.org/10.1371/journal.pone.0139605

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.

In: PloS one, Vol. 10, No. 10, e0139605, 14.10.2015.

Research output: Contribution to journalArticle

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T1 - Comparing cost-effectiveness of HIV testing strategies

T2 - Targeted and routine testing in Washington, DC

AU - Castel, Amanda D.

AU - Choi, Sungwoog

AU - Dor, Avi

AU - Skillicorn, Jennifer

AU - Peterson, James

AU - Rocha, Nestor

AU - Kharfen, Michael

PY - 2015/10/14

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N2 - 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.

AB - 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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