Paul G. Farnham

A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status

Background:Alternatives to conventional HIV counseling and testing (HIV-CT) have been used to improve receipt of HIV test results. Objectives:To determine the effectiveness of alternative HIV-CT methods on the receipt of HIV test results. Methods:Studies were identified by a systematic search of the literature using English-language databases from 1990 to 2005. Studies were included if they used an alternative method for HIV-CT, reported the receipt of HIV test results and had a comparison group. Pooled effect sizes [risk ratios (RR)] were calculated using a random effects model. Results:Seventeen effect sizes (k) were included n = 21 096). Alternative HIV-CT methods included rapid testing (k = 12), oral fluid testing (k = 2), home testing (k = 1), and telephone post-test counseling (k = 2). All alternatives except for oral fluid testing significantly increased receipt of results compared with conventional testing. In stratified analysis, rapid testing was most effective [RR, 1.80; 95% confidence interval (CI), 1.46–2.22] followed by telephone post-test counseling (RR, 1.38. 95% CI, 1.24–1.47). Conclusions:There is strong evidence that clients are substantially more likely to receive their HIV test results with rapid testing than with conventional tests or other alternatives. Therefore, to increase knowledge of HIV status, rapid testing is preferable in settings with low rates of return for test results.

The economic burden of HIV in the united states in the era of highly active antiretroviral therapy : Evidence of continuing racial and ethnic differences

Background:Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources. Objective:To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates. Methods:We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature. Results:The cost of new HIV infections in the United States in 2002 is estimated at

Comparing the Costs of HIV Screening Strategies and Technologies in Health-Care Settings

36.4 billion, including

Human immunodeficiency virus retesting during pregnancy: costs and effectiveness in preventing perinatal transmission

6.7 billion in direct medical costs and

The impact of citizen influence on local government expenditure

29.7 billion in productivity losses. Direct medical costs per case were highest for whites (

Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings

180,900) and lowest for blacks (

Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States: late versus early diagnosis and entry into care.

160,400). Productivity losses per case were lowest for whites (

The cost-effectiveness of pre-exposure prophylaxis in men who have sex with men in the United States: an epidemic model.

661,100) and highest for Hispanics (

Cost effectiveness of the National HIV/AIDS Strategy goal of increasing linkage to care for HIV-infected persons.

838,000). In a sensitivity analysis, universal use of ART and more effective ART regimens decreased the overall cost of illness. Conclusion:Direct medical costs and productivity losses of HIV/AIDS resulting from infections diagnosed in 2002 are substantial. Productivity losses far surpass direct medical costs and are disproportionately borne by minority races/ethnicities. Our analysis underscores economic benefits of more effective ART regimens and universal access to ART.

Lifetime costs and quality-adjusted life years saved from HIV prevention in the test and treat era.

Objectives. In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine human immunodeficiency virus (HIV) screening for people aged 13 to 64 years in all U.S. health-care settings. Earlier recommendations focused on those at high risk for HIV and included more extensive pretest counseling. HIV screening may also involve either rapid or conventional testing. The purpose of this research was to estimate the costs of these different testing procedures and the cost per HIV-infected patient correctly receiving test results in three health-care scenarios that illustrated these policy differences. Methods. The study estimated the costs of rapid and conventional HIV testing in the following scenarios: (1) sexually transmitted disease (STD) clinic counseling and testing (CT), (2) STD clinic screening, and (3) emergency department (ED) screening. Costs were estimated from the provider perspective in 2006 dollars. A decision analytic model was developed to estimate the cost per HIV-infected patient notified of test results using the two testing procedures in the three scenarios. Results. Although the complete rapid testing procedure was more expensive than conventional testing, the cost per HIV-infected patient receiving test results was lower for the rapid test compared with conventional testing in all scenarios. Per-patient costs of receiving results were lowest in the ED screening scenario and highest in the STD CT scenario. These costs were sensitive to changes in test costs, HIV prevalence, and return rates following conventional tests. Conclusion. HIV screening in general health-care settings is economically feasible, particularly with rapid tests that lower the cost of HIV-infected patients receiving their test results.