HIV Screening and Testing

For Public Health

What to know

HIV testing and screening are important first steps in diagnosing infection. Diagnosing HIV infection early is cost-effective and saves the public money on direct medical costs. Expanding HIV testing saves lives and prevents others from getting infected.
A doctor wearing gloves collects blood from a patient.

The benefits of HIV screening and testing

In 2020, 30,403 persons received a new diagnosis of HIV infection.1 HIV testing is the vital first step for HIV care and effective prevention. These persons, who had been living with undiagnosed HIV infection, learn their status and have the opportunity to receive life-saving treatment and greatly reduce their risk for transmitting the virus to others. Persons without HIV infection learn about effective tools for reducing their risk for acquisition, including PrEP.

Cost-effectiveness of HIV screening and testing

Initial studies reported voluntary HIV screening to be cost-effective in health care settings in which HIV undiagnosed infection is ≥0.1%,2,3 and more cost-effective than many established screening programs for chronic diseases (e.g., hypertension, colon cancer, and breast cancer). 3 HIV testing and diagnosis increases survival resulting from an earlier initiation of therapy before severe immunologic compromise occurs, which also lowers treatment costs.

Effectiveness of expanded testing in the United States

More frequent screening (such as annual) among populations at increased risk of HIV acquisition has been recommended by CDC since 2006 4 and revised for gay, bisexual and other men who have sex with men in 2017. 5 More frequent screening has also been demonstrated to be cost effective for MSM, and to reduce transmissions of HIV. 6

During 2007–2010, the CDC-funded Expanded Testing Initiate sites tested 2.7 million persons for HIV, identified 0.7% new HIV infections, averted 3,381 additional HIV infections and saved $1,043,503,000, or a return on investment of $9.26 for every dollar invested in the Initiative.7 For every $1.00 spent on HIV testing, CDC saved society almost $2.00 on direct medical costs.

CDC-funded HIV testing programs have substantial reach in the United States. An estimated one-third of all new HIV diagnoses during 2010 – 2017 resulted from a CDC-funded HIV test. 8

As more and more persons receive a diagnosis of HIV infection, the percentage of persons who are unaware of their HIV infection decreases. More people with HIV were aware of their status in 2021 than 2017, with an uptick from 86% aware of their status in 2021 compared to 87% in 2017. 9 Estimated annual new HIV infections were also 12% lower in 2021 compared to 2017, dropping from about 36,500 infections to about 32,100. The decline was driven by a 34% decrease in new infections among 13- to 24-year-olds, mostly among gay and bisexual males. 9

Data from several modeling studies demonstrate that large-scale increases in HIV testing across settings with a high burden of HIV may produce the largest incidence reductions to support the US Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections 90% by 2030. The authors describe the evidence supporting the value of expanded HIV testing, identify challenges in implementation, and present recommendations to address these barriers through approaches at local and federal levels to reach EHE targets. 10

CDC used HHS Minority HIV/AIDS funds to invest a total of $4.5 million in three jurisdictions to implement key foundational activities to help accelerate progress toward ending the HIV epidemic. The successes and lessons learned from these sites will be shared to support nationwide EHE efforts. From July to December 2019, Jumpstart Sites implemented and accelerated key EHE strategies in their communities. This link describes these success stories: https://www.cdc.gov/endhiv/action/jumpstart.html

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Content Source:
National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention
  • Centers for Disease Control and Prevention. HIV Surveillance Report, 2020; vol. 33. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2022
  • Walensky RP, Weinstein MC, Kimmel AD, et al. Routine human immunodeficiency virus testing: an economic evaluation of current guidelines. Am J Med 2005;118:292–300.
  • Paltiel AD, Weinstein MC, Kimmel AD, et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med 2005;352:586–95.
  • Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006;55(No. RR14)
  • DiNenno EA, Prejean J, Delaney KP, Bowles K, Martin T, Tailor A, Dumitru G, Mullins MM, Hutchinson A, Lansky A. Evaluating the Evidence for More Frequent Than Annual HIV Screening of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From a Systematic Review and CDC Expert Consultation. Public Health Rep. 2018 Jan/Feb;133(1):3-21. doi: 10.1177/0033354917738769. Epub 2017 Nov 28. PMID: 29182894; PMCID: PMC5805092.
  • Neilan AM, Bulteel AJB, Hosek SG, Foote JHA, Freedberg KA, Landovitz RJ, Walensky RP, Resch SC, Kazemian P, Paltiel AD, Weinstein MC, Wilson CM, Ciaranello AL. Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States. Clin Infect Dis. 2021 Oct 5;73(7):e1927-e1935. doi: 10.1093/cid/ciaa1061. PMID: 32730625; PMCID: PMC8492162.
  • Hutchinson, Angela B. PhD, MPH; Farnham, Paul G. PhD; Duffy, Nadezhda MD, MPH; Wolitski, Richard J. PhD; Sansom, Stephanie L. PhD, MPP, MPH; Dooley, Samuel W. MD; Cleveland, Janet C. PhD; Mermin, Jonathan H. MD, MPH. Return on Public Health Investment: CDC's Expanded HIV Testing Initiative. JAIDS Journal of Acquired Immune Deficiency Syndromes 59(3):p 281-286, March 1, 2012. | DOI: 10.1097/QAI.0b013e31823e5bee
  • Williams W, Krueger A, Wang G, Patel D, Belcher L. The contribution of HIV testing funded by the Centers for Disease Control and Prevention to HIV diagnoses in the United States, 2010-2017. J Community Health. 2021;46(4):832-841.
  • CDC. Estimated HIV Incidence and Prevalence in the United States, 2017–2021. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/index.html May 2023. Accessed July 19 2023.
  • Bohdan Nosyk and others, The Testing Imperative: Why the US Ending the Human Immunodeficiency Virus (HIV) Epidemic Program Needs to Renew Efforts to Expand HIV Testing in Clinical and Community-Based Settings, Clinical Infectious Diseases, Volume 76, Issue 12, 15 June 2023, Pages 2206–2208, https://doi.org/10.1093/cid/ciad103