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

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.

Challenges in Translating PrEP Interest Into Uptake in an Observational Study of Young Black MSM

“…At visits, participants are tested for HIV using a rapid test, syphilis, and urethral and rectal chlamydia and gonorrhea. HIV-negative participants receive qualitative HIV nucleic-acid amplification testing (NAAT), as part of an acute HIV-infection detection protocol [15]. All participants receive comprehensive HIV/STI risk-reduction counseling which includes the provision of condoms and lubricant.…”

Partner services in adults with acute and early HIV infection

“…Beginning in 2007, HIV nucleic acid testing (NAT) (Procleix HIV-1/HCV Assay: Chiron, Emeryville, California, and Genprobe, San Diego, California) was provided to all HIV Ab negative persons regardless of symptoms and exposures (i.e. universal screening for AHI) 16-20 . AHI was defined by a negative or indeterminate HIV Ab test in the presence of detectable HIV-1 RNA, corresponding to Fiebig stages I-II.…”

Differences in Risk Behavior and Demographic Factors Between Men Who Have Sex With Men With Acute and Nonacute Human Immunodeficiency Virus Infection in a Community-Based Testing Program in Los Angeles

“…4-9,13,23-27 A recent study found that testing for acute HIV infection was cost-effective in preventing new HIV infections among at risk MSM in San Diego as well as other MSM populations with similar HIV prevalence but lower proportions of diagnosis of acute HIV infection. 28 …”