HIV testing options: the dollars and sense.

The Centers for Disease Control and Prevention's recommended strategy of routine opt-out HIV testing, in which all 13-64-year-olds receiving services in any health care setting would be offered testing but could decline the offer, may not be the best approach. (1) According to one analysis, more than 65 million Americans a year would be tested under this approach, 56,940 individuals with undiagnosed HIV infection would be reached and 3,644 transmissions and infections would be averted; the cost per transmission or infection averted would come to about $237,000. By contrast, if health care providers offered targeted counseling and testing to individuals at high risk of infection, close to 30 million men and women would be reached, including 188,170 who were unaware that they were HIV-positive, and 14,553 transmissions and infections would be averted; the cost per averted transmission or infection would be an estimated $59,000. (Total costs for both programs would be the same--about $865 million annually.) The targeted approach maintained its edge in analyses using varying assumptions about HIV prevalence and the effectiveness of counseling. Although the analyst describes multiple limitations of his work, he believes that if funding were available for one of these options, "the better investment would be a highly targeted program."

(1.) Holtgrave DR, Costs and consequences of the US Centers for Disease Control and Prevention's recommendations for opt-out HIV testing, PLoS Medicine, 2007, 4(6):e194, <http:// medicine.plosjournals.org/perlserv/ ?request=get-document& doi=10.137l%2Fjournal.pmed. 0040194>, accessed June 27, 2007.