The Cost of Implementing Rapid HIV Testing in Sexually Transmitted Disease Clinics in the United States

Abstract

Introduction Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV-infected. Methods We determined the cost to sexually transmitted disease clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk-reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared to current testing practices. Results Criteria for offering rapid HIV testing and methods for delivering non-rapid test results varied among clinics prior to the trial. Rapid HIV testing cost an average of $22/patient without brief risk-reduction counseling and $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were $1,100 and $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of $19,500 to a cost of $40,700 without counseling and a cost of $98,000 to $153,900 with counseling. Conclusions Universal rapid HIV testing in sexually transmitted disease clinics with same day results can be implemented at relatively low cost to STD clinics, if brief risk-reduction counseling is not offered.

The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic

“…17–22 Given that only a portion of visits will be billed to insurance, results suggest that a clinic might not be financially viable if only billed to Medicaid, but could be financially viable when other types of insurance reimbursements are available. Broadly speaking, the results suggest that an STD clinic can be viable, even when not all visits are billed to an insurer, and provide services even to those who are uninsured without facing a deficit.…”

“…Micro-costing studies in health care identify and measure all costs and sources of income associated with delivery of a given healthcare service, 16 and have been previously conducted in STD care settings with the goal of determining cost effectiveness and informing policy. 17–22 Most have focused on HIV only. 17–22 No previous studies in the U.S. have assessed overall operational costs of an STD clinic.…”

“…17–22 Most have focused on HIV only. 17–22 No previous studies in the U.S. have assessed overall operational costs of an STD clinic.…”

The Optimal Age for Screening Adolescents and Young Adults Without Identified Risk Factors for HIV

“…(See appendix Table A1. ) c HIV screen cost was derived from an average of reported costs with and without counseling at sexually transmitted infection clinics [14]. The cost of completing a positive screen was based on average reported costs at hospitals [15].…”

A mixed methods study of HIV-related services in buprenorphine treatment

“…Rapid HIV testing only requires a non-intrusive oral swab that yields initial results in a brief period of time [ 15 ]. Rapid HIV tests that are marketed directly to consumers cost less than $50 [ 16 ], and in health care settings, per-patient costs have been estimated at $22–$46 per patient depending on the counseling protocol [ 17 ]. Furthermore, HIV testing is included among the preventive services that are covered under the Affordable Care Act [ 18 ].…”