Expanded Screening for HIV in the United States — An Analysis of Cost-Effectiveness

Paltiel, A. David; Weinstein, Milton C.; Kimmel, April D.; Seage, George R.; Losina, Elena; Zhang, Hong; Freedberg, Kenneth A.; Walensky, Rochelle P.

doi:10.1056/nejmsa042088

Cited by 498 publications

(423 citation statements)

References 21 publications

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“…[20][21][22] Normalizing HIV testing in the minds of the general public is important. Freely available materials in the proper language and educational level should accompany Asians=Pacific Islanders, American Indians=Alaska Natives, and persons of multiple races were excluded because numbers were too small for meaningful analysis.…”

Section: Individuals With Dates Of Initial Hiv Diagnosis In Southmentioning

confidence: 99%

“…Three recently published papers concerning the cost-effectiveness of HIV screening concluded that even when the prevalence of HIV infection in specific populations is substantially lower than 1%, screening for HIV is cost effective relative to other established screening programs. [20][21][22] And while the public health benefits are clearindividuals on therapy have more productive lives, avert opportunistic infections, as well as secondary transmissionsthe costs associated with routine screening are not trivial. Although most practitioners would agree that providing accessible testing benefits patients, the capacity of treatment and preventive services will need to be increased if routine HIV testing is to translate into earlier treatment.…”

Section: Individuals With Dates Of Initial Hiv Diagnosis In Southmentioning

confidence: 99%

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Risk-Based HIV Testing in South Carolina Health Care Settings Failed to Identify the Majority of Infected Individuals

Duffus

Weis

Kettinger

et al. 2009

AIDS Patient Care and STDs

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To provide evidence of large numbers of missed opportunities for early HIV diagnosis we designed a retrospective cohort study linking surveillance data from the South Carolina HIV=AIDS Reporting System to a statewide all payer health care database. We determined visits and diagnoses occurring before the date of the first positive HIV test and medical encounters were categorized to distinguish visits that were likely versus unlikely to have prompted an HIV test. Of the 4117 HIV-positive individuals newly diagnosed between 2001 and 2005, 3021 (73.4%) visited a South Carolina health care facility one or more times prior to testing HIV positive. Of these 3021, 1311 (43.4%) were late testers, and 1425 (47.2%) were early testers. Females were less likely than males to be late testers (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.45-0.68), blacks were more likely than whites to be late testers (OR 1.37, 95% CI 1.10-1.71), and persons 50 years of age and older more likely to be late testers (OR 7.16,. A total of 78.8% of the 13,448 health care visits for both late and early testers were for health care diagnoses unlikely to prompt an HIV test. These findings underscore the need for more routine HIV testing of adults and adolescents visiting health care facilities in order to facilitate early diagnosis.

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Section: Individuals With Dates Of Initial Hiv Diagnosis In Southmentioning

confidence: 99%

Section: Individuals With Dates Of Initial Hiv Diagnosis In Southmentioning

confidence: 99%

Risk-Based HIV Testing in South Carolina Health Care Settings Failed to Identify the Majority of Infected Individuals

Duffus

Weis

Kettinger

et al. 2009

AIDS Patient Care and STDs

View full text Add to dashboard Cite

show abstract

“…Patients diagnosed and treated for HIV avoid hospitalizations and can reduce risky behaviors, further reducing HIV transmission 4 .…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Routine HIV Testing in VA Primary Care

et al. 2009

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“…This cost/ QALY rose to nearly $40 000/QALY with a seroprevalence of only 0.1%. The second study, by Paltiel, 21 demonstrated that the cost/QALY of one-time testing of patients with a 1% seroprevalence to be $38 000.…”

Section: Costmentioning

confidence: 99%

“…Finally, with the demonstrated added value of hospitalist programs 33 and the recent literature demonstrating the cost effectiveness of routine HIV testing, 20,21 hospitalists are well suited to demonstrate leadership in the acquisition of the resources required to make routine inpatient HIV testing possible.…”

Section: Hospitalists At the Helm Of Routine Inpatient Hiv Testingmentioning

confidence: 99%

Routine rapid HIV testing in hospitals: Another opportunity for hospitalists to improve care

Greenwald

2006

Journal of Hospital Medicine

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BACKGROUNDThe Centers for Disease Control and Prevention recommends routinely offering HIV testing to inpatients at hospitals with an HIV seroprevalence rate of greater than 1% or an AIDS diagnosis rate of greater than 1.0 per 1000 discharges. This recommendation has not been widely adopted, perhaps because of one of several barriers: the cost of implementing a counseling and testing program; the logistics of HIV counseling and testing on a hospital ward particularly with respect to privacy; concern about the follow‐up of HIV test results necessitating patients to return after discharge; and the cultural mindset of screening as an outpatient modality complicated by the fear of raising the possibility of HIV testing and therefore eliciting a negative reaction from a patient who has not requested it.PURPOSEThis article focuses on these barriers and some possible solutions, emphasizing the role of FDA‐approved rapid HIV tests, which may decrease follow‐up issues for HIV testing programs. It also considers hospitalists, given their frontline status and ability to coordinate the multidisciplinary services and systemwide approach required to implement such a program, as leaders in this area. Journal of Hospital Medicine 2006;1:106–112. © 2006 Society of Hospital Medicine

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Expanded Screening for HIV in the United States — An Analysis of Cost-Effectiveness

Abstract: In all but the lowest-risk populations, routine, voluntary screening for HIV once every three to five years is justified on both clinical and cost-effectiveness grounds. One-time screening in the general population may also be cost-effective.

Cited by 498 publications

References 21 publications

Risk-Based HIV Testing in South Carolina Health Care Settings Failed to Identify the Majority of Infected Individuals

Risk-Based HIV Testing in South Carolina Health Care Settings Failed to Identify the Majority of Infected Individuals

Barriers and Facilitators to Routine HIV Testing in VA Primary Care

Routine rapid HIV testing in hospitals: Another opportunity for hospitalists to improve care

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