Cost-Effectiveness of Finding New HIV Diagnoses Using Rapid HIV Testing in Community-Based Organizations

Objective. We assessed the cost-effectiveness of determining new human immunodeficiency virus (HIV) diagnoses using rapid HIV testing performed by community-based organizations (CBOs) in Kansas City, Missouri, and Detroit, Michigan. Methods. The CBOs performed rapid HIV testing during April 2004 through March 2006. In Kansas City, testing was performed in a clinic and in outreach settings. In Detroit, testing was performed in outreach settings only. Both CBOs used mobile testing vans. Measures of effectiveness were the number of HIV tests performed and the number of people notified of new HIV diagnoses, based on rapid tests. We retrospectively collected program costs, including those for personnel, test kits, mobile vans, and facility space. Results. The CBO in Kansas City tested a mean of 855 people a year in its clinic and 703 people a year in outreach settings. The number of people notified of new HIV diagnoses was 19 (2.2%) in the clinic and five (0.7%) in outreach settings. The CBO in Detroit tested 976 people a year in outreach settings, and the number notified of new HIV diagnoses was 15 (1.5%). In Kansas City, the cost per person notified of a new HIV diagnosis was $3,637 in the clinic and $16,985 in outreach settings. In the Detroit outreach settings, the cost per notification was $13,448. Conclusions. The cost of providing a new HIV diagnosis was considerably higher in the outreach settings than in the clinic. The variation can be largely explained by differences in the number of undiagnosed infections among the people tested and by the costs of purchasing and operating a mobile van.

Download Full-text

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

10.21203/rs.3.rs-132840/v1 ◽

2020 ◽

Author(s):

Shanzi Huang ◽

Jason Ong ◽

Wencan Dai ◽

Xi He ◽

Yi Zhou ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Testing ◽

Variable Cost ◽

Community Based ◽

Self Testing ◽

Hiv Test ◽

Community Based Organization ◽

The Mean ◽

The Cost ◽

Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

Download Full-text

Cost of OraQuick oral fluid rapid HIV testing at 35 community clinics and community-based organizations in the USA

AIDS Care ◽

10.1080/09540120902729940 ◽

2009 ◽

Vol 21 (9) ◽

pp. 1157-1162 ◽

Cited By ~ 7

Author(s):

Steven D. Pinkerton ◽

Laura M. Bogart ◽

Devery Howerton ◽

Susan Snyder ◽

Kirsten Becker ◽

...

Keyword(s):

Hiv Testing ◽

Oral Fluid ◽

Community Based ◽

Community Clinics ◽

Rapid Hiv Testing ◽

Community Based Organizations ◽

The Usa

Download Full-text

Economic evaluation of HIV testing options for low-prevalence high-income countries: a systematic review

Health Economics Review ◽

10.1186/s13561-021-00318-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Olanrewaju Medu ◽

Adegboyega Lawal ◽

Doug Coyle ◽

Kevin Pottie

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Hiv Testing ◽

High Income ◽

Economic Evaluations ◽

Rapid Hiv Testing ◽

The Cost ◽

Low Prevalence

Abstract Introduction This study reviewed the economic evidence of rapid HIV testing versus conventional HIV testing in low-prevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches. Methods A systematic search of selected databases for relevant English language studies published between Jan 1, 2001, and Jan 30, 2019, was conducted. The methodological design quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Drummond tool. We reported the systematic review according to the PRISMA guidelines. Results Five economic evaluations met the eligibility criteria but varied in comparators, evaluation type, perspective, and design. The methodologic quality of the included studies ranged from medium to high. We found evidence to support the cost-effectiveness of rapid HIV testing approaches in low-prevalence high-income countries. Rapid HIV testing was associated with cost per adjusted life year (QALY), ranging from $42,768 to $90,498. Additionally, regardless of HIV prevalence, rapid HIV testing approaches were the most cost-effective option. Conclusions There is evidence for the cost-effectiveness of rapid HIV testing, including the use of saliva-based testing compared to usual care or hospital-based serum testing. Further studies are needed to draw evidence on the relative cost-effectiveness of the distinct options and contexts of rapid HIV testing.

Download Full-text

Provider-related Barriers to Rapid HIV Testing in U.S. Urban Non-profit Community Clinics, Community-based Organizations (CBOs) and Hospitals

AIDS and Behavior ◽

10.1007/s10461-008-9456-3 ◽

2008 ◽

Vol 14 (3) ◽

pp. 697-707 ◽

Cited By ~ 14

Author(s):

Laura M. Bogart ◽

Devery Howerton ◽

James Lange ◽

Claude Messan Setodji ◽

Kirsten Becker ◽

...

Keyword(s):

Hiv Testing ◽

Community Based ◽

Community Clinics ◽

Non Profit ◽

Rapid Hiv Testing ◽

Community Based Organizations

Download Full-text

The cost-effectiveness of rapid HIV testing in substance abuse treatment: Results of a randomized trial

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2012.08.009 ◽

2013 ◽

Vol 128 (1-2) ◽

pp. 90-97 ◽

Cited By ~ 20

Author(s):

Bruce R. Schackman ◽

Lisa R. Metsch ◽

Grant N. Colfax ◽

Jared A. Leff ◽

Angela Wong ◽

...

Keyword(s):

Substance Abuse ◽

Cost Effectiveness ◽

Substance Abuse Treatment ◽

Randomized Trial ◽

Hiv Testing ◽

Treatment Results ◽

Rapid Hiv Testing ◽

Abuse Treatment ◽

The Cost

Download Full-text

Rapid HIV Testing in Transgender Communities by Community-Based Organizations in Three Cities

Public Health Reports ◽

10.1177/00333549081230s313 ◽

2008 ◽

Vol 123 (3_suppl) ◽

pp. 101-114 ◽

Cited By ~ 82

Author(s):

Jeffrey D. Schulden ◽

Binwei Song ◽

Alex Barros ◽

Azul Mares-DelGrasso ◽

Charles W. Martin ◽

...

Keyword(s):

New York ◽

Hiv Infection ◽

Hiv Testing ◽

Risk Behaviors ◽

Newly Diagnosed ◽

Community Based ◽

Rapid Hiv Testing ◽

Prevention Services ◽

Community Based Organizations ◽

The Past

Objectives. This article describes the demographic and behavioral characteristics, human immunodeficiency virus (HIV) testing history, and results of HIV testing of transgender (TG) people recruited for rapid HIV testing by community-based organizations (CBOs) in three cities. Methods. CBOs in Miami Beach, Florida, New York City, and San Francisco offered TG people rapid HIV testing and prevention services, and conducted a brief survey. Participants were recruited in outreach settings using various strategies. The survey collected information on demographic characteristics, HIV risk behaviors, and HIV testing history. Results. Among 559 male-to-female (MTF) TG participants, 12% were newly diagnosed with HIV infection. None of the 42 female-to-male participants were newly diagnosed with HIV. A large proportion of MTF TG participants reported high-risk behaviors in the past year, including 37% who reported unprotected receptive anal intercourse and 44% who reported commercial sex work. Several factors were independently associated with increased likelihood of being newly diagnosed with HIV infection among MTF TG participants, including having a partner of unknown HIV status in the past year; being 20–29 or ≥40 years of age; having last been tested for HIV more than 12 months ago; and having been recruited at the New York City site. Conclusions. Based on the high proportion of undiagnosed HIV infection among those tested, TG people represent an important community for enhanced HIV testing and prevention efforts. MTF TG people should be encouraged to have an HIV test at least annually or more often if indicated, based upon clinical findings or risk behaviors. Efforts should continue for developing novel strategies to overcome barriers and provide HIV testing and prevention services to TG people.

Download Full-text

HIV Testing Histories and Risk Factors Among Migrants and Recent Immigrants Who Received Rapid HIV Testing from Three Community-Based Organizations

Journal of Immigrant and Minority Health ◽

10.1007/s10903-013-9811-y ◽

2013 ◽

Vol 16 (5) ◽

pp. 798-810 ◽

Cited By ~ 11

Author(s):

Jeffrey D. Schulden ◽

Thomas M. Painter ◽

Binwei Song ◽

Eduardo Valverde ◽

Mary Ann Borman ◽

...

Keyword(s):

Risk Factors ◽

Hiv Testing ◽

Community Based ◽

Recent Immigrants ◽

Rapid Hiv Testing ◽

Community Based Organizations

Download Full-text

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20982773 ◽

2021 ◽

pp. 1357633X2098277

Author(s):

Molly Jacobs ◽

Patrick M Briley ◽

Heather Harris Wright ◽

Charles Ellis

Keyword(s):

Cost Effectiveness ◽

Economies Of Scale ◽

Reference Group ◽

Unit Cost ◽

Community Based ◽

Face To Face ◽

Conduction Aphasia ◽

Aphasia Treatment ◽

The Cost ◽

The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Download Full-text