The cost-effectiveness of rapid HIV testing in substance abuse treatment: Results of a randomized trial.
This is the Results Article for CTN-0032-A-1.
The President’s National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral.
This article reports on outcomes from ancillary investigation CTN-0032-A-1 (“Economic Analysis of HIV Rapid Testing in Drug Abuse Treatment Programs”) in which the cost-effectiveness of three HIV testing strategies used in 12 community-based substance abuse treatment programs was evaluated: off-site testing referral, on-site rapid testing with information only, and on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%), and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Referral for off-site testing was found to be less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,400/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit.
Conclusions: A strategy of on-site rapid HIV testing offered with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio < $100,000/QALY. Policy makers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested.
Related protocols: CTN-0032-A-1