title: Targeting the use of pooled HIV RNA screening to reduce cost in health department STD clinics: New York City, 2009-2011.
abstract: OBJECTIVE
  Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection.
  
  
  METHODS
  From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011).
  
  
  RESULTS
  During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed.
  
  
  CONCLUSIONS
  Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Disease Control, Queens, NY.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Borges
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Disease Control, Queens, NY.
authors.forename: Preeti
authors.initials: P
authors.lastname: Pathela
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Public Health Laboratory, Queens, NY.
authors.forename: Robert
authors.initials: R
authors.lastname: Pirillo
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Disease Control, Queens, NY ; Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention, Atlanta, GA.
authors.forename: Susan
authors.initials: S
authors.lastname: Blank
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D009519:New York City; D021141:Nucleic Acid Amplification Techniques; D012367:RNA, Viral; D012307:Risk Factors; D012737:Sex Factors; D019529:Sexuality
chemical_list: D012367:RNA, Viral