Abstract
Few groups in the United States (US) are as heavily affected by HIV as men who have sex with men (MSM), yet many MSM remain unaware of their infection. HIV diagnosis is important for decreasing onward transmission and promoting effective treatment for HIV, but the cost-effectiveness of testing programs is not well-established. This study reports on the costs and cost-utility of the MSM Testing Initiative (MTI) to newly diagnose HIV among MSM and link them to medical care. Cost and testing data in 15 US cities from January 2013 to March 2014 were prospectively collected and combined to determine the cost-utility of MTI in each city in terms of the cost per Quality Adjusted Life Years (QALY) saved from payer and societal perspectives. The total venue-based HIV testing costs ranged from $18,759 to $564,284 for nine to fifteen months of MTI implementation. The cost-saving threshold for HIV testing of MSM was $20,645 per new HIV diagnosis. Overall, 27,475 men were tested through venue-based MTI, of whom 807 (3 %) were newly diagnosed with HIV. These new diagnoses were associated with approximately 47 averted HIV infections. The cost per QALY saved by implementation of MTI in each city was negative, indicating that MTI venue-based testing was cost-saving in all cities. The cost-utility of social network and couples testing strategies was, however, dependent on whether the programs newly diagnosed MSM. The cost per new HIV diagnosis varied considerably across cities and was influenced by both the local cost of MSM testing implementation and by the seropositivity rate of those reached by the HIV testing program. While the cost-saving threshold for HIV testing is highly achievable, testing programs must successfully reach undiagnosed HIV-positive individuals in order to be cost-effective. This underscores the need for HIV testing programs which target and engage populations such as MSM who are most likely to have undiagnosed HIV to maximize programmatic benefit and cost-utility.
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References
Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. HIV Surveill Suppl Rep. 2012;17(4):1–26.
Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas. HIV Surveill Suppl Rep. 2014;19(3).
Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. New Engl J Med. 2009;360(18):1815–26.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New Engl J Med. 2011;365(6):493–505.
Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301(22):2380–2.
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.
Jia Z, Mao Y, Zhang F, Ruan Y, Ma Y, Li J, et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study. Lancet. 2013;382(9899):1195–203.
Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas. HIV Surveill Rep. 2013;2013:25 Epub February 2015.
Wejnert C, Le B, Rose CE, Oster AM, Smith AJ, Zhu J, et al. HIV infection and awareness among men who have sex with men-20 cities, United States, 2008 and 2011. PloS One. 2013;8(10):e76878.
Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17.
Centers for Disease Control and Prevention. HIV Testing among men who have sex with men— 21 Cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2011;60(21):694–9.
MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men–a national application of venue-based, time-space sampling. Public health Rep. 2007;122(Suppl 1):39–47.
Centers for Disease Control And Prevention. testing together 2015. Available from: https://effectiveinterventions.cdc.gov/en/HighImpactPrevention/PublicHealthStrategies/CHTC.aspx.
Centers for Disease Control And Prevention. social network strategy (SNS) for CTR 2015. Available from: https://effectiveinterventions.cdc.gov/en/HighImpactPrevention/PublicHealthStrategies/SocialNetworkStrategy.aspx.
Kim JJ, Maulsby C, Zulliger R, Jain K, Positive Charge Intervention T, Charles V, et al. Cost and threshold analysis of positive charge, a multi-site linkage to HIV care program in the United States. AIDS Behav. 2015;19(10):1735–41.
Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.
Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):1632–6.
Farnham PG, Gopalappa C, Sansom SL, Hutchinson AB, Brooks JT, Weidle PJ, et al. 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. J Acquir Immune Defic Syndr. 2013;64(2):183–9.
Farnham PG, Holtgrave DR, Gopalappa C, Hutchinson AB, Sansom SL. Lifetime costs and quality-adjusted life years saved from HIV prevention in the test and treat era. J Acquir Immune Defic Syndr. 2013;64(2):e15–8.
CPI for All urban consumers (CPI-U) 1982–84 = 100 (Unadjusted)—CUUR0000SA0 [Internet]. 2014.
Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on cost-effectiveness in health and medicine. Jama. 1996;276(16):1339–41.
Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the panel on cost-effectiveness in health and medicine. Jama. 1996;276(15):1253–8.
Walensky RP, Freedberg KA, Weinstein MC, Paltiel AD. Cost-effectiveness of HIV testing and treatment in the United States. Clin Infect Dis. 2007;45(Suppl 4):S248–54.
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This cost analysis was funded by Abt Associates grant number 112476.
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Rose Zulliger, Cathy Maulsby, Liza Solomon, Chanza Baytop, Alex Orr, Muazzam Nasrullah, Luke Shouse, Elizabeth DiNenno, and David Holtgrave have no conflicts of interest to disclose.
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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services.
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Zulliger, R., Maulsby, C., Solomon, L. et al. Cost-utility of HIV Testing Programs Among Men Who Have Sex with Men in the United States. AIDS Behav 21, 619–625 (2017). https://doi.org/10.1007/s10461-016-1547-y
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DOI: https://doi.org/10.1007/s10461-016-1547-y