title: Cost effectiveness analysis of the New Jersey rapid testing algorithm for HIV testing in publicly funded testing sites.
abstract: BACKGROUND
  Before 2009, New Jersey (NJ) publicly funded counseling and testing sites (CTS) tested for HIV using a single rapid test followed, when positive, by a Western Blot (WB) for confirmation. With this strategy, 74.8% of confirmed positive clients returned to receive test results. To improve the client notification rate at these centers, the New Jersey (NJ) Division of HIV, STD and TB Services (DHSTS) implemented a rapid testing algorithm (RTA) which utilizes a second, different, rapid test to verify a preliminary positive.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of the two testing algorithms.
  
  
  METHODS
  This was a retrospective cost-effectiveness analysis.
  
  
  METHODS
  New Jersey HIV Rapid Testing Support Program (NJHIV) records, DHSTS grant documents, counseling time estimates from an online survey of site supervisors. Costs included test kits and personnel costs from month of RTA implementation through 11/30 in 2008 and 2009. The incremental cost of the RTA was calculated per additional percent of positive clients who were notified and per day earlier notification.
  
  
  RESULTS
  In 2008, 215 of 247 clients with a positive rapid HIV test were confirmed positive by WB. 90.9% of clients were notified a mean of 11.4 days after their initial test. 12 refused confirmatory WB. In 2009, 152 of 170 clients with one positive rapid test had a confirmatory second positive rapid test and were notified on the same day. The incremental cost of the RTA was $20.31 per additional positive person notified and $24.31 per day earlier notification or $3.23 per additional positive person and $3.87 per day earlier notification if the WB were eliminated.
  
  
  CONCLUSIONS
  The RTA is a cost-effective strategy achieving 100% notification of newly HIV positive clients a mean of 11.4 days earlier compared to standard testing.
authors.affiliation: UMDNJ School of Public Health, 683 Hoes Lane, Piscataway, NJ 08854, USA. klsmargiotta@mac.com
authors.forename: Kendall
authors.initials: K
authors.lastname: Stevinson
authors.forename: Eugene G
authors.initials: EG
authors.lastname: Martin
authors.forename: Stephen
authors.initials: S
authors.lastname: Marcella
authors.forename: Sindy M
authors.initials: SM
authors.lastname: Paul
mesh_terms: D000465:Algorithms; D015153:Blotting, Western / Q000191:economics; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D018563:Disease Notification / Q000191:economics; D006678:HIV / Q000276:immunology / Q000472:pathogenicity; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000276:immunology / Q000821:virology; D017048:Health Care Costs; D006801:Humans; D007124:Immunoenzyme Techniques / Q000191:economics*; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D009515:New Jersey; D011933:Reagent Kits, Diagnostic / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D011933:Reagent Kits, Diagnostic