HIV Screening and Testing
Prevention Case Study 1
In 2015, approximately 39,000 persons received a new diagnosis of HIV infection. 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.
- Initial studies reported voluntary HIV screening to be cost-effective in health care settings in which HIV undiagnosed infection is ≥0.1%,1,2 and more cost-effective than many established screening programs for chronic diseases (e.g., hypertension, colon cancer, and breast cancer). 2,3 HIV testing and diagnosis increases survival resulting from an earlier initiation of therapy before severe immunologic compromise occurs, which also lowers treatment costs.
- A more recent study reported that HIV testing in clinical settings is cost-saving by using a model with consistent, standardized methods of evaluating the costs and effects of established and emerging HIV prevention strategies.4 The unit cost of testing was adjusted by the positivity rate of persons tested (0.6%), drawn from reports of HIV testing at CDC-funded sites, to derive a cost per new diagnosis. The estimated cost per case of HIV prevented for testing in clinical settings was less than the lifetime treatment cost per HIV case, indicating that the intervention was cost-saving.
- During 2007–2010, the CDC-funded Expanded Testing Initiate sites provided >2.8 million HIV tests that resulted in approximately 18,000 new HIV diagnoses and helped avert $1.2 billion in direct medical costs.4 For every $1.00 spent on HIV testing, CDC saved society $2.00 on direct medical costs.
- CDC-funded HIV testing programs have substantial reach in the United States. Approximately one-third of all new HIV diagnoses in 2013 were through a CDC-funded HIV test.5
- As more and more persons receive a diagnosis of HIV infection, the percentage of persons who are unaware of their HIV infection decreases. In 2006, 19% of persons with HIV were unaware of their infection; in 2014, this decreased to 15%.6 Some of the greatest improvements have occurred among young gay and bisexual males aged 13–24 years,7 who previously were at highest risk for HIV infection.
- 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.
- Sanders GD, Bayoumi AM, Sundaram V, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med 2005;352:570–85.
- Lin F, Farnham PG, Shrestha RK, Mermin J, Sansom SL. Cost effectiveness of HIV prevention interventions in the U.S. Am J Prev Med 2016; 50:699–708.
- Krueger A, Dietz P, Van Handel M, Belcher L, Johnson AS. Estimates of CDC-funded and national HIV diagnoses: a comparison by demographic and HIV-related factors. AIDS Behav 2016;20:2961–5.
- Satcher Johnson A, Song R, Hall HI. State-level estimates of HIV incidence, prevalence, and undiagnosed infections [Abstract 899]. Presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 13–16, 2017.
- Singh S, Song R, Satcher Johnson A, McCray E, Hall HI. HIV incidence, prevalence and undiagnosed infections in men who have sex with men [Abstract 30]. Presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 13–16, 2017.