Eggman Ashley A, Feaster Daniel J, Leff Jared A, Golden Matthew R, Castellon Pedro C, Gooden Lauren, Matheson Tim, Colfax Grant N, Metsch Lisa R, Schackman Bruce R
From the *Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY; †Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL; ‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY; §Public Health-Seattle and King County, Seattle, WA; and ¶San Francisco Department of Public Health, San Francisco, CA.
Sex Transm Dis. 2014 Sep;41(9):545-50. doi: 10.1097/OLQ.0000000000000168.
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.
We 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. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected 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 $1100 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.
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.
在高危人群中开展快速艾滋病毒检测，可增加知晓自身艾滋病毒感染状况的人数，并避免耗费门诊资源去查找已确诊感染艾滋病毒的人员。
我们利用2010年7家参与快速检测随机试验的公立诊所的数据，确定了即时护理快速艾滋病毒检测对性传播疾病（STD）诊所造成的成本。这些诊所开展了有无以患者为中心的简短风险降低咨询的快速检测。成本包括咨询员和培训员的时间、用品及诊所间接费用。我们采用了全国劳动力费率和检测成本。我们计算了诊所的中位数启动成本以及每位接受检测患者的平均成本，并预测了与当前检测做法相比实施普遍快速艾滋病毒检测的年度增量成本。
在试验前，各诊所提供快速艾滋病毒检测的标准以及传递非快速检测结果的方法各不相同。在这7家诊所中，不提供简短风险降低咨询时，快速艾滋病毒检测每位患者的平均成本为22美元，提供咨询时则为46美元。每家诊所的中位数启动成本在不提供咨询时为1100美元，提供咨询时为16100美元。实施普遍快速艾滋病毒检测每家诊所估计的年度增量成本因是否开展简短咨询以及当前诊所检测做法而异，在不提供咨询时从节省19500美元到成本40700美元不等，提供咨询时成本则从98000美元到153900美元不等。
如果不提供简短风险降低咨询，在STD诊所开展当日出结果的普遍快速艾滋病毒检测，对STD诊所而言成本相对较低。
