The cost of implementing rapid HIV testing in sexually transmitted clinics in the United States.

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. For this analysis, the authors determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. National labor rates and test costs were applied, and the authors also calculated median clinic start-up costs and mean cost per patient tested, as well as projecting incremental annual costs of implementing universal rapid HIV testing compared with current testing practices.

Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US$22/patient without brief risk reduction counseling and US$46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US$1,100 and US$16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US$19,500 to a cost of US$40,700 without counseling and a cost of US$98,000 to US$153,900 with counseling.

Conclusions: Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics if brief risk reduction counseling is not offered. STD clinics may be able to reallocate savings from less case finding for newly identified HIV-positive individuals lost to follow-up to offset some of these incremental costs. The benefits to patients may be substantial, including more rapid identification and linkage to care of HIV-infected individuals, avoiding return visits to receive results, and less emotional stress waiting for results.

Related protocols: CTN-0032, Project AWARE