Division of Infectious Disease, Massachusetts General Hospital, United States; General Medicine, Department of Medicine, Massachusetts General Hospital, United States; Division of Infectious Disease, Brigham and Women's Hospital, Harvard University Center for AIDS Research, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard University Center for AIDS Research, United States; Harvard Medical School, Boston, MA, United States; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Perinatal HIV Research Unit, Johannesburg, South Africa; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States; Yale School of Medicine, New Haven, CT, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
Walensky, R.P., Division of Infectious Disease, Massachusetts General Hospital, United States, General Medicine, Department of Medicine, Massachusetts General Hospital, United States, Division of Infectious Disease, Brigham and Women's Hospital, Harvard University Center for AIDS Research, United States, Harvard Medical School, Boston, MA, United States; Wood, R., Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Fofana, M.O., General Medicine, Department of Medicine, Massachusetts General Hospital, United States; Martinson, N.A., School of Medicine, Johns Hopkins University, Baltimore, MD, United States, Perinatal HIV Research Unit, Johannesburg, South Africa; Losina, E., Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard University Center for AIDS Research, United States, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States, Yale School of Medicine, New Haven, CT, United States; April, M.D., Harvard Medical School, Boston, MA, United States; Bassett, I.V., Division of Infectious Disease, Massachusetts General Hospital, United States, General Medicine, Department of Medicine, Massachusetts General Hospital, United States, Harvard Medical School, Boston, MA, United States; Morris, B.L., General Medicine, Department of Medicine, Massachusetts General Hospital, United States; Freedberg, K.A., Division of Infectious Disease, Massachusetts General Hospital, United States, General Medicine, Department of Medicine, Massachusetts General Hospital, United States, Harvard Medical School, Boston, MA, United States, Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; Paltiel, A.D., Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
Background:: Although 900,000 HIV-infected South Africans receive antiretroviral therapy, the majority of South Africans with HIV remain undiagnosed. Methods: We use a published simulation model of HIV case detection and treatment to examine 3 HIV screening scenarios, in addition to current practice as follows: (1) one-time; (2) every 5 years; and (3) annually. South African model input data include the following: 16.9% HIV prevalence, 1.3% annual incidence, 49% test acceptance rate, HIV testing costs of $6.49/patient, and a 47% linkage-to-care rate (including 2 sequential antiretroviral therapy regimens) for identified cases. Outcomes include life expectancy, direct medical costs, and incremental cost-effectiveness. Results: HIV screening one-time, every 5 years, and annually increase HIV-infected quality-adjusted life expectancy (mean age 33 years) from 180.6 months (current practice) to 184.9, 187.6, and 197.2 months. The incremental cost-effectiveness of one-time screening is dominated by screening every 5 years. Screening every 5 years and annually each have incremental cost-effectiveness ratios of $1570/quality-adjusted life year and $1720/quality-adjusted life year. Screening annually is very cost-effective even in settings with the lowest incidence/prevalence, with test acceptance and linkage rates both as low as 20%, or when accounting for a stigma impact at least four-fold that of the base case. Conclusions: In South Africa, annual voluntary HIV screening offers substantial clinical benefit and is very cost-effective, even with highly constrained access to care and treatment. © 2010 by Lippincott Williams & Wilkins.