title: Costs of Rapid HIV Screening in an Urban Emergency Department and a Nearby County Jail in the Southeastern United States.
abstract: Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA) Jail in 2011. The two sites, four miles apart from one another, employed the same rapid HIV test. Ascertainment that cases were new differed by site; only the jail systematically checked identities against health department HIV registries. The program in the emergency department used dedicated HIV test counselors and made 242 diagnoses over a 40-month period at a cost of $2,981 per diagnosis. The jail program used staff nurses, and found 41 new HIV cases over 10.5 months at a cost of $6,688 per new diagnosis. Differences in methods for ascertainment of new diagnoses, previously undiagnosed HIV sero-positivity, and methodologies used for assessing program costs prevent concluding that one program was more economical than the other. Nonetheless, our findings show that testing in both venues yielded many new diagnoses, with the costs within the range reported in the literature.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Spaulding
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: MacGowan
authors.affiliation: Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America.
authors.forename: Brittney
authors.initials: B
authors.lastname: Copeland
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Ram K
authors.initials: RK
authors.lastname: Shrestha
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Chava J
authors.initials: CJ
authors.lastname: Bowden
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Min J
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Margolis
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Genetha
authors.initials: G
authors.lastname: Mustaafaa
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Reid
authors.affiliation: Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Heilpern
authors.affiliation: Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America.
authors.forename: Bijal B
authors.initials: BB
authors.lastname: Shah
mesh_terms: D002947:Cities; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005845:Georgia; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D011330:Prisons / Q000191:economics*