Screening for Acute HIV Infection in Community-based Settings: Cost Effectiveness and Impact on Transmissions

Hoenigl, M, A Chaillon, SR Mehta, DM Smith, J Graff Zivin, and SJ Little, “Screening for Acute HIV Infection in Community-based Settings: Cost Effectiveness and Impact on Transmissions” Journal of Infection, 73(2016): 476-484.

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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.