Targeted Testing More Effective Than Mass Testing

David Holtgrave, PhD, professor and chair of the Bloomberg School’s Department of Health, Behavior and Society determined that the Centers for Disease Control and Prevention’s (CDC) testing strategy is likely to cost $864 million for one year. For the same price, a targeted testing and counselling approach would identify more than three times as many people with HIV and could prevent four times as many new HIV infections.

The CDC estimates that 25 percent of Americans with HIV do not know they are HIV positive. Because they are unaware, they do not seek treatment and are at greater risk of spreading HIV to others. To identify more Americans with HIV, the CDC has recommended that doctors in the United States test all patients aged 13 to 64 for HIV at every health care visit, unless the patient opts out, or specifically declines to be tested. In order to meet the demands of more testing, doctors can forgo the HIV risk reduction counselling that usually accompanies HIV testing.

Using standard methods of cost-effectiveness analysis, Holtgrave estimates that CDC’s recommended opt-out testing program would cost $864 million. For the same cost, a program of targeted counselling and testing would diagnose 188,170 new HIV infections, compared with 56,940 that would be detected through CDC’s testing plan, assuming one percent of the population tested is HIV positive.

Additionally, targeted counselling and testing would prevent an estimated 14,553 new HIV infections at a cost of $59,383 per infection prevented, compared to 3,644 from opt-out testing at a cost of $237,149 per infection prevented. Further, Holtgrave says that targeted testing and counselling perform better than opt-out testing in several key outcomes even when the rate of HIV infection in the community is 0.3 percent.; Source: Johns Hopkins University Bloomberg School of Public Health