The clinical impact and cost-effectiveness of routine, voluntary HIV screening in South Africa

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 56; no. 1; p. 26
• Main Authors: Walensky, Rochelle P, Wood, Robin, Fofana, Mariam O, Martinson, Neil A, Losina, Elena, April, Michael D, Bassett, Ingrid V, Morris, Bethany L, Freedberg, Kenneth A, Paltiel, A David
• Format: Journal Article
• Language: English
• Published: United States 01.01.2011
• Subjects: Adult; AIDS Serodiagnosis - economics; AIDS Serodiagnosis - statistics & numerical data; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Cost-Benefit Analysis; Costs and Cost Analysis; Diagnostic Tests, Routine - economics; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - mortality; HIV Infections - prevention & control; Humans; Life Expectancy; Mass Screening - economics; Models, Theoretical; Social Stigma; South Africa - epidemiology; Time Factors; Voluntary Programs - economics; South Africa
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e3181fb8f24

Although 900,000 HIV-infected South Africans receive antiretroviral therapy, the majority of South Africans with HIV remain undiagnosed. 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. 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. 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.