Researchers show cost-effectiveness of HIV testing in drug abuse treatment programs

September 9, 2012

Less than half of community-based substance abuse treatment programs in the United States currently make HIV testing available on-site or through referral. A new study led by researchers at Weill Cornell Medical College shows the cost-effectiveness of integrating on-site rapid HIV testing into drug treatment programs.

The study, published in today's issue of Drug and Alcohol Dependence, is a collaboration with the HIV Rapid Testing and Counseling Study trial, sponsored by the National Drug Abuse Clinical Trials Network. The randomized clinical trial conducted in 12 community-based substance abuse in 2009 found that 80 percent of the participants offered on-site HIV testing with a rapid test accepted the testing offer and obtained test results, as compared with less than 20 percent of those referred for off-site testing. These recent results were published in the June issue of the .

The new study measured the cost-effectiveness of on-site rapid HIV testing in programs using data from the HIV Rapid Testing and Counseling Study, including patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed and program costs. Researchers used the Cost Effectiveness of Preventing AIDS Complications (CEPAC) to project life expectancy, lifetime costs and quality-adjusted life years (QALYs) for the HIV-infected individuals. The researchers calculated the cost per QALY with and without on-site testing, also taking into account the costs associated with testing individuals who turn out not to be HIV-infected.

"Our cost-effectiveness analysis supports integrating HIV screening and prevention services with substance abuse treatment programs, which is called for in President 's National HIV/AIDS Strategy, " says the study's lead investigator Dr. Bruce R. Schackman, an associate professor of public health and chief of the Division of Health Policy at Weill Cornell Medical College. "We found that on-site testing with a description of the testing procedure, without pre- risk-reduction counseling, resulted in a beneficial cost-effectiveness ratio. This strategy provides better value than off-site referral."

Study results show a cost-effectiveness ratio of $60,300 per QALY, which is below one acceptable cost-effectiveness threshold of $100,000 per QALY used in the U.S. In addition, researchers found that participant-tailored risk-reduction counseling does not provide better value in this setting. Risk-reduction counseling increases the cost per participant by nearly 90 percent, and in the trial it had no significant effect on self-reported sexual risk behavior.

Although medical advances over the past 15 years have made HIV a substantially manageable illness, new HIV cases in the U.S. continue to emerge at a steady rate. More than 20 percent of infected individuals are unaware of their infection and are therefore not treated. This both reduces their life expectancy and quality of life and makes them more likely to transmit the infection to others. To identify more people infected with HIV, in 2006 the Centers for Disease Control and Prevention (CDC) recommended routine for all adults in health care settings, as well as expanding testing in non-medical settings.

"This study shows that introducing on-site rapid HIV testing to treatment programs should be an important element of the CDC's strategy to identify and treat HIV-infected persons earlier to improve their lives and reduce transmission," says study co-author Dr. Lisa R. Metsch, the Stephen Smith professor and chair of sociomedical sciences at the Mailman School of Public Health at Columbia University and the principal investigator of the initial HIV Rapid Testing and Counseling Study. "The study provides strong evidence of the societal value of on-site HIV testing. We need to overcome barriers to implementing HIV testing in non-medical settings for those not recently tested."

"The study reinforces the clinical and economic value of offering on-site rapid HIV testing in drug abuse treatment programs by demonstrating its cost-effectiveness," says senior author Dr. Rochelle P. Walensky, associate professor of medicine at Harvard Medical School and Massachusetts General Hospital. "Our study should serve as motivation for policymakers and substance leaders to seek funding for on-site in programs."

Explore further: IU expert: Current HIV testing approach 'not doing the job'

Related Stories

IU expert: Current HIV testing approach 'not doing the job'

June 28, 2012
Beth Meyerson, co-chair of the Rural Center for AIDS/STD Prevention at Indiana University, said expanding HIV testing is critical.

Recommended for you

Scientists find where HIV 'hides' to evade detection by the immune system

October 19, 2017
In a decades-long game of hide and seek, scientists from Sydney's Westmead Institute for Medical Research have confirmed for the very first time the specific immune memory T-cells where infectious HIV 'hides' in the human ...

National roll-out of PrEP HIV prevention drug would be cost-effective

October 18, 2017
Providing pre-exposure prophylaxis (PrEP) medication to men who have sex with men who are at high risk of HIV infection (equivalent to less than 5% of men who have sex with men at any point in time) in England would be cost-effective, ...

Regulatory T cells harbor HIV/SIV virus during antiviral drug treatment

October 17, 2017
Scientists at Yerkes National Primate Research Center, Emory University have identified an additional part of the HIV reservoir, immune cells that survive and harbor the virus despite long-term treatment with antiviral drugs.

New research opens the door to 'functional cure' for HIV

October 17, 2017
In findings that open the door to a completely different approach to curing HIV infections, scientists from the Florida campus of The Scripps Research Institute (TSRI) have for the first time shown that a novel compound effectively ...

Researchers create molecule that could 'kick and kill' HIV

October 5, 2017
Current anti-AIDS drugs are highly effective at making HIV undetectable and allowing people with the virus to live longer, healthier lives. The treatments, a class of medications called antiretroviral therapy, also greatly ...

A sixth of new HIV patients in Europe 50 or older: study

September 27, 2017
People aged 50 and older comprise a growing percentage of HIV patients in Europe, accounting for one in six new cases in 2015, researchers said Wednesday.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.