Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia.

Objective and Methods Russia has one of the fastest growing HIV epidemics in the world, and screening has been widespread. Whether such screening is an effective use of resources is unclear. We used epidemiologic and economic data from Russia to develop a Markov model to estimate costs, quality of life, and survival associated with a voluntary HIV screening program compared to no screening in Russia. We measured discounted lifetime health care costs and quality-adjusted life years (QALYs) gained. We varied our inputs in sensitivity analysis. Results Early identification of HIV through screening provided a substantial benefit to persons with HIV, increasing life expectancy by 2.1 years and 1.7 QALYs. At a base-case prevalence of 1.2%, once-per-lifetime screening cost $13,396 per QALY gained, exclusive of benefit from reduced transmission. Cost-effectiveness of screening remained favorable until prevalence dropped below 0.04%. When HIV transmission-related costs and benefits were included, once-per-lifetime screening cost $6,910 per QALY gained, and screening every two years cost $27,696 per QALY gained. An important determinant of the cost-effectiveness of screening was effectiveness of counseling about risk reduction. Conclusions Early identification of HIV infection through screening in Russia is effective and cost-effective in all but the lowest prevalence groups.