Cost-effectiveness of finding new HIV diagnoses using rapid HIV testing in community-based organizations.
OBJECTIVE
We assessed the cost-effectiveness of determining new human immunodeficiency virus (HIV) diagnoses using rapid HIV testing performed by community-based organizations (CBOs) in Kansas City, Missouri, and Detroit, Michigan.


METHODS
The CBOs performed rapid HIV testing during April 2004 through March 2006. In Kansas City, testing was performed in a clinic and in outreach settings. In Detroit, testing was performed in outreach settings only. Both CBOs used mobile testing vans. Measures of effectiveness were the number of HIV tests performed and the number of people notified of new HIV diagnoses, based on rapid tests. We retrospectively collected program costs, including those for personnel, test kits, mobile vans, and facility space.


RESULTS
The CBO in Kansas City tested a mean of 855 people a year in its clinic and 703 people a year in outreach settings. The number of people notified of new HIV diagnoses was 19 (2.2%) in the clinic and five (0.7%) in outreach settings. The CBO in Detroit tested 976 people a year in outreach settings, and the number notified of new HIV diagnoses was 15 (1.5%). In Kansas City, the cost per person notified of a new HIV diagnosis was $3,637 in the clinic and $16,985 in outreach settings. In the Detroit outreach settings, the cost per notification was $13,448.


CONCLUSIONS
The cost of providing a new HIV diagnosis was considerably higher in the outreach settings than in the clinic. The variation can be largely explained by differences in the number of undiagnosed infections among the people tested and by the costs of purchasing and operating a mobile van.
Shrestha
Ram K
RK
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-48, Atlanta, GA 30333, USA. biu0@cdc.gov
Clark
Hollie A
HA
Sansom
Stephanie L
SL
Song
Binwei
B
Buckendahl
Holly
H
Calhoun
Cindy B
CB
Hutchinson
Angela B
AB
Heffelfinger
James D
JD
D015492:AIDS Serodiagnosis / Q000191:economics*; D003153:Community Health Services; D003362:Cost-Benefit Analysis; D037001:Directive Counseling / Q000191:economics; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008923:Missouri; D012189:Retrospective Studies