The cost-effectiveness of symptom-based testing and routine screening for acute HIV infection in men who have sex with men in the USA
- 10 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 25 (14), 1779-1787
- https://doi.org/10.1097/qad.0b013e328349f067
Abstract
Objective: Acute HIV infection often causes influenza-like illness (ILI) and is associated with high infectivity. We estimated the effectiveness and cost-effectiveness of strategies to identify and treat acute HIV infection in men who have sex with men (MSM) in the USA. Design: Dynamic model of HIV transmission and progression. Interventions: We evaluated three testing approaches: viral load testing for individuals with ILI, expanded screening with antibody testing, and expanded screening with antibody and viral load testing. We included treatment with antiretroviral therapy for individuals identified as acutely infected. Main outcome measures: New HIV infections, discounted quality-adjusted life years (QALYs) and costs, and incremental cost-effectiveness ratios. Results: At the present rate of HIV-antibody testing, we estimated that 538 000 new infections will occur among MSM over the next 20 years. Expanding antibody screening coverage to 90% of MSM annually reduces new infections by 2.8% and costs US$ 12 582 per QALY gained. Symptom-based viral load testing with ILI is more expensive than expanded antibody screening, but is more effective and costs US$ 22 786 per QALY gained. Combining expanded antibody screening with symptom-based viral load testing prevents twice as many infections compared to expanded antibody screening alone, and costs US$ 29 923 per QALY gained. Adding viral load testing to all annual HIV tests costs more than US$ 100 000 per QALY gained. Conclusion: Use of HIV viral load testing in MSM with ILI prevents more infections than does expanded annual antibody screening alone and is inexpensive relative to other screening interventions. Clinicians should consider symptom-based viral load testing in MSM, in addition to encouraging annual antibody screening.This publication has 30 references indexed in Scilit:
- Faculty Opinions recommendation of Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.Published by H1 Connect ,2006
- The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United StatesMedical Care, 2006
- Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City MenAnnals of Internal Medicine, 2006
- Detection of Acute HIV Infections in High-Risk Patients in CaliforniaJAIDS Journal of Acquired Immune Deficiency Syndromes, 2006
- The Effect of Diagnosis with HIV Infection on Health-Related Quality of LifeQuality of Life Research, 2006
- Human Immunodeficiency Virus (HIV) Risk, Prevention, and Testing Behaviors--United States, National HIV Behavioral Surveillance System: Men Who Have Sex with Men, November 2003-April 2005Morbidity and Mortality Weekly Report, 2006
- The Cost-Effectiveness of Expanded Testing for Primary HIV InfectionAnnals of Family Medicine, 2005
- Targeted screening for primary HIV infection through pooled HIV-RNA testing in men who have sex with menAIDS, 2005
- Detection of Acute Infections during HIV Testing in North CarolinaThe New England Journal of Medicine, 2005
- Cost-Effectiveness of Screening for HIV in the Era of Highly Active Antiretroviral TherapyThe New England Journal of Medicine, 2005