title: Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC.
abstract: BACKGROUND
  Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.
  
  
  METHODS
  We sought to evaluate the cost effectiveness of the District of Columbia (DC) Department of Health's routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations); collected testing and labor costs; and calculated effectiveness measures including cost per new diagnosis and cost per averted transmission.
  
  
  RESULTS
  Compared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%). Routine testing averted 34.30 transmissions per year compared to targeted testing at 17.78. The cost per new diagnosis was lower for targeted testing ($2,467 vs. $7,753 per new diagnosis) as was the cost per transmission averted ($33,160 vs. $104,205). When stratified by testing site, both testing approaches were most cost effective in averting new transmissions when conducted by community based organizations ($25,037 routine; $33,123 targeted) compared to hospitals or clinics.
  
  
  CONCLUSIONS
  While routine testing identified more newly diagnosed infections and averted more infections than targeted testing, targeted testing is more cost effective per diagnosis and per transmission averted overall. Given the high HIV prevalence in DC, the DC Department of Health's implementation strategy should continue to encourage routine testing implementation with emphasis on a combined testing strategy among community-based organizations.
authors.affiliation: The Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Castel
authors.affiliation: The George Washington University School of Public Policy and Public Administration, Washington, DC, United States of America.
authors.forename: Sungwoog
authors.initials: S
authors.lastname: Choi
authors.affiliation: The Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America.
authors.forename: Avi
authors.initials: A
authors.lastname: Dor
authors.affiliation: The Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Skillicorn
authors.affiliation: The Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Peterson
authors.affiliation: District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, TB Administration, Washington, DC, United States of America.
authors.forename: Nestor
authors.initials: N
authors.lastname: Rocha
authors.affiliation: District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, TB Administration, Washington, DC, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Kharfen
mesh_terms: D000328:Adult; D001741:Black or African American; D002487:Centers for Disease Control and Prevention, U.S.; D003140:Communicable Disease Control / Q000379:methods*; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D004219:District of Columbia; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D011634:Public Health; D014481:United States; D055815:Young Adult