title: Outcomes and cost analysis of 3 operational models for rapid HIV testing services in an academic inner-city emergency department.
abstract: OBJECTIVE
  We compare the outcomes and costs of alternative staffing models for an emergency department (ED) rapid HIV testing program.
  
  
  METHODS
  A rapid oral-fluid HIV testing program was instituted in an inner-city ED in 2005. Three staffing models were compared during 24.5 months: indigenous medical staff only, exogenous staff only, or exogenous staff plus medical staff (hybrid). Personnel obtained written consent and provided brief pretest counseling, obtained kits, collected specimens, returned specimens to the ED satellite laboratory, and performed posttest counseling and referral to care. Cost analysis was performed to estimate cost per patient tested and cost per patient linked to care.
  
  
  RESULTS
  Overall, 44 of 2,958 (1.5%) patients tested received confirmed positive results and 30 (68%) were linked to care. The exogenous staff only model yielded the highest number tested per month (587), and indigenous medical staff only yielded the lowest (57). Significantly higher positivity rates were found in both indigenous medical staff only (2.2%) and hybrid (2.0%) models versus the exogenous staff only model (0.6%) (prevalence rate ratio: 3.7 [95% confidence interval {CI}1.5 to 9.3] versus 3.4 [95% CI 1.5 to 7.8], respectively). All patients with confirmed positive results were linked to care in the indigenous medical staff only model but only approximately 60% were linked to care in the 2 other models (linked to care rate ratio versus exogenous staff only: 1.8 [95% CI 1.1 to 4.4]; versus hybrid: 1.7 [95% CI 1.2 to 2.5]). The indigenous medical staff only model had the highest cost ($109) per patient tested, followed by the hybrid ($87) and the exogenous staff only ($39). However, the indigenous medical staff only model had the lowest cost ($4,937) per patient linked to care, followed by the hybrid ($7,213) and exogenous staff only ($11,454).
  
  
  CONCLUSIONS
  The exogenous staff only model tested the most patients at the least cost per patient tested. The indigenous medical staff only model identified the fewest patients with unrecognized HIV infection and had the highest cost per patient tested but the lowest cost per patient linked to care.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. yhsieh1@jhmi.edu
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Julianna J
authors.initials: JJ
authors.lastname: Jung
authors.forename: Judy B
authors.initials: JB
authors.lastname: Shahan
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pollack
authors.forename: Heather S
authors.initials: HS
authors.lastname: Hairston
authors.forename: Daniel
authors.initials: D
authors.lastname: Moring-Parris
authors.forename: G D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D017721:Hospital Costs; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems / Q000191:economics; D015995:Prevalence; D012189:Retrospective Studies