HIV screening via fourth-generation immunoassay or nucleic acid amplification test in the United States: a cost-effectiveness analysis

At least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation i...

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Bibliographic Details
Published in:PloS one 2011-11, Vol.6 (11), p.e27625-e27625
Main Author: Long, Elisa F
Format: Article
Language:English
Subjects:
Acids
Acute Disease - epidemiology
Adolescent
Adult
Amplification
Analysis
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Behavior
Biology
Clinical outcomes
Cost analysis
Cost benefit analysis
Costs
Demographics
Disease control
Disease prevention
Disease transmission
Drug abuse
Drug therapy
Economic aspects
Epidemiology
Female
Health aspects
Health care costs
Health insurance
HIV
HIV infections
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - transmission
HIV tests
Homosexuality, Male - statistics & numerical data
Human immunodeficiency virus
Humans
Immunoassay
Immunoassay - economics
Incidence
Infection
Infections
Male
Mass Screening - economics
Medicaid
Medical research
Medical screening
Medical tests
Medicare
Medicine
Mens health
Middle Aged
Models, Biological
Mortality
Nucleic Acid Amplification Techniques - economics
Prevention
Sensitivity analysis
Sexual behavior
Sexually transmitted diseases
Social and Behavioral Sciences
STD
Test procedures
Time Factors
United States
Young Adult
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Summary:At least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation immunoassay tests. Using a dynamic HIV transmission model instantiated with U.S. epidemiologic, demographic, and behavioral data, I estimated the number of acute infections identified, HIV infections prevented, quality-adjusted life years (QALYs) gained, and the cost-effectiveness of alternative screening strategies. I varied the target population (everyone aged 15-64, injection drug users [IDUs] and men who have sex with men [MSM], or MSM only), screening frequency (annually, or every six months), and test(s) utilized (fourth-generation immunoassay only, or immunoassay followed by pooled NAAT). Annual immunoassay testing of MSM reduces incidence by 9.5% and costs
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0027625