Cost-Effectiveness of Frequent HIV Testing of High-Risk Populations in the United States

Hutchinson, Angela B.; Farnham, Paul G.; Sansom, Stephanie L.; Yaylalı, Emine; Mermin, Jonathan

doi:10.1097/qai.0000000000000838

Cited by 46 publications

(55 citation statements)

References 37 publications

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“…[14,15,26] In the USA, where MSM are more aware of their HIV serostatus than in Peru, testing is more frequent and frequent testing has been shown to be cost-effective. [24,27] Additionally, consistent with the literature, our study found higher educational attainment was associated with participants knowing their HIV-infection status. [11,28] This suggests that strategies that encourage and facilitate frequent HIV testing among MSM and transgender women, particularly those with lower educational attainment, could be beneficial.…”

Section: Discussionsupporting

confidence: 89%

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

et al. 2016

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The aim of the study was to identify factors associated with undiagnosed human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) and male-to-female transgender women in Lima, Peru.We analyzed characteristics of 378 MSM and transgender women recruited from 2 sexually transmitted infection (STI) clinics in Lima, Peru. Descriptive analyses compared: (A) HIV-uninfected, (B) previously undiagnosed HIV-infected, and (C) previously diagnosed HIV-infected participants. Multivariable logistic regression models identified: (1) correlates of previously undiagnosed HIV-infection among participants thought to be HIV-uninfected (B vs A); and (2) correlates of previously undiagnosed HIV-infection among HIV-infected participants (B vs C). Subanalysis identified correlates of frequent HIV testing among participants thought to be HIV-uninfected.Among participants, 31.0% were HIV-infected; of those, 35.0% were previously undiagnosed. Among participants thought to be HIV-uninfected (model 1), recent condomless receptive anal intercourse and last HIV test being over 1-year ago (compared to within the last 6-months) were associated with increased odds of being previously undiagnosed HIV-infected (adjusted odds ratio [aOR] = 2.43, 95% confidence interval [95%CI] = 1.10–5.36; aOR = 2.87, 95%CI = 1.10–7.53, respectively). Among HIV-infected participants (model 2), recent condomless receptive anal intercourse was again associated with previously undiagnosed HIV-infection (aOR = 2.54, 95%CI = 1.04–6.23). Achieving post-secondary education and prior syphilis infection were associated with lower odds of having previously undiagnosed HIV-infection (aOR = 0.35, 95%CI = 0.15–0.81; aOR = 0.32, 95%CI = 0.14–0.75, respectively).Reporting semiannual testing was associated with higher educational attainment, identifying as a transgender woman, or reporting a history of syphilis (aOR = 1.94, 95%CI = 1.11–3.37; aOR = 2.40, 95%CI = 1.23–4.70; aOR = 2.76, 95%CI = 1.62–4.71, respectively). Lower odds of semiannual testing were associated with recent condomless insertive anal intercourse or reporting a moderate or high self-perceived risk of acquiring HIV (aOR = 0.56, 95%CI = 0.33–0.96; aOR = 0.32, 95%CI = 0.18–0.59 and aOR = 0.43, 95%CI = 0.21–0.86, respectively).In our study, undiagnosed HIV-infection was associated with recent condomless receptive anal intercourse, infrequent HIV testing, lower education, and absence of prior syphilis diagnosis. Infrequent HIV testing was associated with lower education, not identifying as transgender, recent condomless insertive anal intercourse, absence of prior syphilis diagnosis, and higher self-perceived risk of HIV. Further efforts to decrease HIV transmission and increase HIV-serostatus awareness should be directed towards effectively promoting condom use and frequent HIV testing, integrated with STI management.

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Section: Discussionsupporting

confidence: 89%

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

et al. 2016

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“…This may be reflected in previously reported increases in HIV diagnoses among young MSM who are most likely to have undiagnosed HIV, and the overall increase in awareness of HIV infection among MSM [4,11]. Annual testing is recommended for sexually active MSM and more frequent testing may be indicated for those at highest risk for HIV infection to detect HIV infection early, which allows risk counseling and initiation of treatment and is cost effective [32-34]. Additional assessments are needed to determine whether testing is not reaching certain subpopulations of MSM at high risk for HIV infection.…”

Section: Discussionmentioning

confidence: 99%

HIV Trends in the United States: Diagnoses and Estimated Incidence

Hall¹,

Song²,

Tang³

et al. 2017

JMIR Public Health Surveill

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BackgroundThe best indicator of the impact of human immunodeficiency virus (HIV) prevention programs is the incidence of infection; however, HIV is a chronic infection and HIV diagnoses may include infections that occurred years before diagnosis. Alternative methods to estimate incidence use diagnoses, stage of disease, and laboratory assays of infection recency. Using a consistent, accurate method would allow for timely interpretation of HIV trends.ObjectiveThe objective of our study was to assess the recent progress toward reducing HIV infections in the United States overall and among selected population segments with available incidence estimation methods.MethodsData on cases of HIV infection reported to national surveillance for 2008-2013 were used to compare trends in HIV diagnoses, unadjusted and adjusted for reporting delay, and model-based incidence for the US population aged ≥13 years. Incidence was estimated using a biomarker for recency of infection (stratified extrapolation approach) and 2 back-calculation models (CD4 and Bayesian hierarchical models). HIV testing trends were determined from behavioral surveys for persons aged ≥18 years. Analyses were stratified by sex, race or ethnicity (black, Hispanic or Latino, and white), and transmission category (men who have sex with men, MSM).ResultsOn average, HIV diagnoses decreased 4.0% per year from 48,309 in 2008 to 39,270 in 2013 (P<.001). Adjusting for reporting delays, diagnoses decreased 3.1% per year (P<.001). The CD4 model estimated an annual decrease in incidence of 4.6% (P<.001) and the Bayesian hierarchical model 2.6% (P<.001); the stratified extrapolation approach estimated a stable incidence. During these years, overall, the percentage of persons who ever had received an HIV test or had had a test within the past year remained stable; among MSM testing increased. For women, all 3 incidence models corroborated the decreasing trend in HIV diagnoses, and HIV diagnoses and 2 incidence models indicated decreases among blacks and whites. The CD4 and Bayesian hierarchical models, but not the stratified extrapolation approach, indicated decreases in incidence among MSM.ConclusionsHIV diagnoses and CD4 and Bayesian hierarchical model estimates indicated decreases in HIV incidence overall, among both sexes and all race or ethnicity groups. Further progress depends on effectively reducing HIV incidence among MSM, among whom the majority of new infections occur.

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“…In high-income countries such as the United Kingdom, annual targeted testing to MSM, IDUs, and people from HIV-endemic countries has been reported to prevent 4%-15% of infections and require testing 2,500 people per HIV diagnosis, with an ICER of £17,500/QALY gained (~$26,700, 2012 USD) [23]. Testing MSM more frequently (at 3 or 6 month intervals) is reported to be cost-effective and even cost-saving in some scenarios over a one-year period in the United States [24]. A study based in Zimbabwe quantified the potential savings in health care costs with HIV self-testing: while only 7,000 DALYs are averted over 20 years in a population of 7.5 million, the authors suggest the $75 million saved by self-testing might be used to avert further DALYs by investing this money in other highly cost-effective prevention or treatment interventions [25].…”

Section: Hiv Prevention Interventionsmentioning

confidence: 99%

Modeling and Cost-Effectiveness in HIV Prevention

Jacobsen

Walensky

2016

Curr HIV/AIDS Rep

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With HIV funding plateauing and the number of people living with HIV increasing due to the roll-out of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology, then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral or community-based interventions, prevention of mother to child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.

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Cost-Effectiveness of Frequent HIV Testing of High-Risk Populations in the United States

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 46 publications

References 37 publications

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

HIV Trends in the United States: Diagnoses and Estimated Incidence

Modeling and Cost-Effectiveness in HIV Prevention

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