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

Abstract

BACKGROUND The President’s National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. METHODS We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. RESULTS Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. CONCLUSIONS A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested.

Effectiveness and feasibility study of routine HIV rapid testing in an urban methadone maintenance treatment program

“…The benefit of on-site HIV testing within the methadone program is consistent with a recent randomized controlled trial by Metsch and colleagues that reported an increase in HIV testing when conducted on-site in addiction treatment programs (5). …”

“…Despite these limitations, this study does demonstrate that a very large urban methadone maintenance program was able to implement routine HIV testing and to identify new HIV cases. Given the clinical importance and cost effectiveness of implementing on-site HIV testing in this population, the blending of HIV testing into the routine admission and annual physical examinations as done in this study may be an important method to increase the uptake of HIV testing in this population (3–5). …”

Sexually transmitted infections and substance use disorders: evidence and challenges in Mexico

“…These benefits of early detection suggest that performing rapid STI tests is highly recommended because: a) it has been shown that they can assist in detection with a diagnostic efficiency level of over 95% (Kyle et al, 2015), b) they are cost-effective and easily transportable (Schackman et al, 2013), c) they are highly accepted by patients (Schackman et al, 2013), and d) they contribute to narrowing the gap between infection and late initiation of treatment (Leber et al, 2015).…”

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs

“…RHT is also highly accurate (Delaney et al, 2011; Pai et al, 2012), and yields preliminary results in 20 minutes or less, which allows testing and notification of results to occur during the same visit. In a recent trial, on-site RHT in substance use disorder treatment programs substantially increased receipt of HIV test results (Metsch et al, 2012) and was cost-effective (Schackman et al, 2013). …”