Cost comparison of three HIV counseling and testing technologies.
BACKGROUND
In the United States, more than 2 million human immunodeficiency virus (HIV) antibody tests are performed annually at publicly funded HIV counseling and testing (CT) clinics. Clients do not receive results from one third of these tests because of low return rates. New rapid-testing technologies may improve receipt of results, but no study has systematically analyzed the costs of these newer technologies compared with the standard protocol.


OBJECTIVE
To estimate and compare the economic costs associated with three HIV CT protocols: the standard protocol and the one-step and two-step rapid protocols.


METHODS
A cost analysis model was developed in 2002 to calculate the intervention costs for HIV CT services with the standard CT protocol and the one-step and two-step rapid-test protocols for a hypothetical client in a publicly funded HIV clinic. Sensitivity analyses were performed to ascertain the effects of uncertainty in the model parameters.


RESULTS
The one-step rapid protocol was generally the least expensive of the three protocols. The standard protocol cost less than the two-step protocol per HIV-positive client notified of his or her HIV status, but cost more per HIV-negative client. The sensitivity analysis indicated overlap in the cost estimates for HIV-negative clients, reflecting the generally similar costs of the three testing protocols. Taking into account HIV seroprevalence, the two-step rapid protocol would be less expensive than the standard protocol for most publicly funded testing programs in the United States.


CONCLUSIONS
Rapid test protocols offer economic advantages as well as convenience, compared to the standard testing protocol. The cost estimates presented here should prove helpful to HIV program managers and other public health decision makers who need information on these counseling and testing technologies.
Ekwueme
Donatus U
DU
Division of HIV/AIDS Prevention-Intervention Research and Support, Centers for Disease Control and Prevention, 4700 Buford Highway N.E., Atlanta, GA 30341, USA. dce3@cdc.gov
Pinkerton
Steven D
SD
Holtgrave
David R
DR
Branson
Bernard M
BM
D015492:AIDS Serodiagnosis / Q000191:economics* / Q000379:methods; D015153:Blotting, Western / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000379:methods; D006678:HIV / Q000302:isolation & purification; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D017048:Health Care Costs / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000191:economics; D009010:Monte Carlo Method; D012680:Sensitivity and Specificity; D014186:Transportation / Q000191:economics
D015483:HIV Antibodies