OBJECTIVES:
Following
national guidelines to expand HIV testing in high-prevalence areas in England,
a number of pilot studies were conducted in acute general medical admission
units (ACUs) and general practices (GPs) to assess the feasibility and
acceptability of testing in these settings. The aim of this study was to
estimate the cost per HIV infection diagnosed through routine HIV testing in
these settings.
METHODS:
Resource
use data from four 2009/2010 Department of Health pilot studies (two ACUs; two
GPs) were analysed. Data from the pilots were validated and supplemented with
information from other sources. We constructed possible scenarios to estimate
the cost per test carried out through expanded HIV testing in ACUs and GPs, and
the cost per diagnosis.
RESULTS:
In the
pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient
uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs,
respectively. In scenario analyses we fixed offer time, diagnostic test cost
and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40%
for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000
tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a
Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed
by either hospital consultants or GPs.
CONCLUSIONS:
Expanded
HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of
a shorter offer time, higher patient uptake, higher HIV positivity and lower
diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV
positivity, expanded HIV testing should be promoted in high HIV prevalence
areas.
By: Ong KJ1, Thornton AC2, Fisher M3, Hutt R4, Nicholson S5, Palfreeman A6, Perry N3, Stedman-Bryce G7, Wilkinson P5, Delpech V1, Nardone A1.
- 1Centre for Infectious Disease Surveillance and Control, Public Health England, UK.
- 2Department of Infection and Population Health, University College London, London, UK.
- 3Brighton and Sussex University Hospital, Brighton, UK.
- 4NHS South East London, Public Health Lewisham, London, UK.
- 5Brighton and Hove City Council, Brighton, UK.
- 6University Hospitals Leicester, Leicester, UK.
- 7Pamoja Consulting, Brighton, UK.
- HIV Med. 2016 Apr;17(4):247-54. doi: 10.1111/hiv.12293. Epub 2015 Sep 23.
OBJECTIVE:
In
response to the current CDC recommendations for routine HIV testing in clinical
settings, the Adolescent AIDS Program at Montefiore Medical Center in the
Bronx, New York, developed the Advise, Consent, Test, Support routine HIV
testing model (ACTS) in 2003. ACTS was piloted in 10 community health centers
operated by Montefiore because they serve populations most at risk for HIV/AIDS.
METHODS:
ACTS
streamlined and codified the counseling and testing process, provided a routine
HIV testing practice change plan, and provided training and communication
materials that promoted routine HIV testing. To determine program success, we
measured the number of patients seen at the clinics, the number of HIV
test-eligible patients (those aged 13-64 years and not pregnant), the number
and percent of patients receiving HIV testing, HIV test results, and the number
of patients linked to care.
RESULTS:
HIV
testing in the 10 sites increased nearly threefold during the pilot period
(2003-2007), from 3,944 of 49,125 eligible patients (8%) tested in 2003 to
11,212 of 55,629 eligible patients (20%) tested in 2007. With little ongoing
support, the sites continued or maintained improvements: 13,226 of 56,686
eligible patients (23%) were tested in 2008, 15,965 of 57,025 eligible patients
(28%) were tested in 2011, 17,483 of 60,514 eligible patients (29%) were tested
in 2012, and 17,971 of 63,172 eligible patients (28%) were tested in 2013.
Sites identified 433 HIV-positive patients from 2006 to 2013 (0.2%-0.6% annual
seropositivity), and 96% of them were linked to care within 90 days of HIV
diagnoses (range: 92% to 98% annually).
CONCLUSION:
ACTS
demonstrated that substantial and sustained increases in routine HIV testing
can be achieved in health-care settings, not by adding personnel or financial
resources, but by using the model's practice change plan and streamlined HIV
testing approach.
- 1Montefiore Medical Center, Adolescent AIDS Program, Bronx, NY.
- 2Montefiore Medical Center, Office of Research Program Development, Bronx, NY.
- 3Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY.
- 4Montefiore Medical Center, Department of Family and Social Medicine, Bronx, NY.
- Public Health Rep. 2016 Jan-Feb;131 Suppl 1:53-62.
PURPOSE:
The
purposes of this study were to document the HIV testing behaviors and
serostatus of younger men of color who have sex with men (YMSM) and to explore
sociodemographic, behavioral, and maternal correlates of HIV testing in the
past 6 months.
RESULTS:
A total
of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the
past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3%
reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of
these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM
(n = 6) were seropositive unaware. Logistic regression results indicated
that maternal communication about sex with males was positively associated with
routine testing. Conversely, communication about puberty and general human sexuality
was negatively associated. Condomless anal intercourse and positive
sexually transmitted infection history were negatively associated with routine
testing; however, frequency of alcohol use was positively associated.
CONCLUSIONS:
Despite
high rates of testing, we found high rates of HIV infection, with 31.58% of
HIV-positive YMSM being seropositive unaware. Mother-son communication about
sex needs to address same-sex behavior as this appears to be more important
than other topics. YMSM with known risk factors for HIV are not testing at the
recommended time intervals.
Via: http://ht.ly/RXypd
By: Bouris A1, Hill BJ2, Fisher K3, Erickson G4, Schneider JA5.
- 1School of Social Service Administration, University of Chicago, Chicago, Illinois; The Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois. Electronic address: abouris@uchicago.edu.
- 2Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
- 3The Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois.
- 4School of Social Service Administration, University of Chicago, Chicago, Illinois.
- 5The Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois; Department of Medicine, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois.
