title: Screening for acute HIV infection in community-based settings: Cost-effectiveness and impact on transmissions.
abstract: To determine cost-effectiveness of three community-based acute HIV infection (AHI) testing algorithms compared to HIV antibody testing alone by focusing on the potential of averting new infections occurring within a one-year time horizon among men who have sex with men (MSM).
  
  
  
  Data sources for model parameters included actual cost and prevalence data derived from a community-based AHI screening program in San Diego, and published studies. Main outcome measure was costs per infection averted (IA). The lower end of the cost range of discounted lifetime costs of an HIV infection (i.e. $236,948) was used for defining cost-effectiveness.
  
  
  
  The most sensitive algorithm for AHI detection, which was based on HIV nucleic acid amplification testing, was estimated to prevent between 5 and 45 transmissions, with simulated costs per infection averted between $965 and $141,256 when compared to HIV antibody testing alone.
  
  
  
  AHI testing was cost-effective in preventing new HIV infections among at risk MSM in San Diego, and also among other MSM populations with similar HIV prevalence but lower proportions of AHI diagnoses. These results indicate that community-based AHI testing among MSM in the United States can pay for itself over the long run.
authors: Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: mhoenigl@ucsd.edu.
authors: Martin
authors: M
authors: Hoenigl
authors: Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States.
authors: Antoine
authors: A
authors: Chaillon
authors: Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States.
authors: Sanjay R
authors: SR
authors: Mehta
authors: Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States.
authors: Davey M
authors: DM
authors: Smith
authors: School of International Relations and Pacific Studies, Department of Economics, UCSD, 9500 Gilman Dr. # 0520, La Jolla, CA 92093, United States.
authors: Joshua
authors: J
authors: Graff-Zivin
authors: Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States.
authors: Susan J
authors: SJ
authors: Little
mesh_terms: D000465:Algorithms; D002140:California / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006293:Health Promotion / Q000191:economics / Q000379:methods; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D011314:Preventive Health Services / Q000191:economics* / Q000379:methods*; D018570:Risk Assessment; D021841:Safe Sex; D012680:Sensitivity and Specificity
keywords: Acute HIV; Cost analysis; HIV transmission; Infection averted; MSM; NAT; Testing