Ekwueme Donatus U, Pinkerton Steven D, Holtgrave David R, Branson Bernard M
Division of HIV/AIDS Prevention-Intervention Research and Support, Centers for Disease Control and Prevention, 4700 Buford Highway N.E., Atlanta, GA 30341, USA.
Am J Prev Med. 2003 Aug;25(2):112-21. doi: 10.1016/s0749-3797(03)00115-6.
In the United States, more than 2 million human immunodeficiency virus (HIV) antibody tests are performed annually at publicly funded HIV counseling and testing (CT) clinics. Clients do not receive results from one third of these tests because of low return rates. New rapid-testing technologies may improve receipt of results, but no study has systematically analyzed the costs of these newer technologies compared with the standard protocol.
To estimate and compare the economic costs associated with three HIV CT protocols: the standard protocol and the one-step and two-step rapid protocols.
A cost analysis model was developed in 2002 to calculate the intervention costs for HIV CT services with the standard CT protocol and the one-step and two-step rapid-test protocols for a hypothetical client in a publicly funded HIV clinic. Sensitivity analyses were performed to ascertain the effects of uncertainty in the model parameters.
The one-step rapid protocol was generally the least expensive of the three protocols. The standard protocol cost less than the two-step protocol per HIV-positive client notified of his or her HIV status, but cost more per HIV-negative client. The sensitivity analysis indicated overlap in the cost estimates for HIV-negative clients, reflecting the generally similar costs of the three testing protocols. Taking into account HIV seroprevalence, the two-step rapid protocol would be less expensive than the standard protocol for most publicly funded testing programs in the United States.
Rapid test protocols offer economic advantages as well as convenience, compared to the standard testing protocol. The cost estimates presented here should prove helpful to HIV program managers and other public health decision makers who need information on these counseling and testing technologies.
在美国，每年在公共资助的艾滋病病毒咨询与检测（CT）诊所进行超过200万次人体免疫缺陷病毒（HIV）抗体检测。由于回访率低，三分之一的检测客户未收到检测结果。新的快速检测技术可能会提高结果的获取率，但尚无研究系统分析这些新技术与标准方案相比的成本。
估计并比较与三种HIV检测方案相关的经济成本：标准方案、一步快速方案和两步快速方案。
2002年开发了一个成本分析模型，用于计算公共资助的HIV诊所中假设客户采用标准检测方案、一步快速检测方案和两步快速检测方案进行HIV检测服务的干预成本。进行敏感性分析以确定模型参数不确定性的影响。
一步快速方案通常是三种方案中成本最低的。对于每一位被告知其HIV感染状况的HIV阳性客户，标准方案的成本低于两步方案，但对于每一位HIV阴性客户，标准方案的成本更高。敏感性分析表明HIV阴性客户的成本估计存在重叠，反映了三种检测方案的成本总体相似。考虑到HIV血清流行率，对于美国大多数公共资助的检测项目，两步快速方案的成本将低于标准方案。
与标准检测方案相比，快速检测方案既具有经济优势又具有便利性。此处给出的成本估计对于需要这些咨询和检测技术信息的HIV项目管理者和其他公共卫生决策者应会有所帮助。
