Cost of finding one newly-diagnosed HIV case in New York City

Background: In 2006, CDC recommended routine HIV screening in healthcare settings. The New York City Department of Health and Mental Hygiene (NYCDOHMH) funds hospitals, clinics, and community-based organizations (CBOs) to conduct HIV testing. The goals of these testing programs are to increase the number of persons tested for HIV and to identify previously undiagnosed HIV cases. We sought to characterize the cost of finding new HIV cases in our funded programs.

Methods: NYCDOHMH reviewed 2006 testing data from its testing programs. We matched identified HIV cases (i.e., persons testing HIV+ by Western blot) to NYCDOHMH's population-based HIV/AIDS Surveillance Registry to determine whether cases were newly diagnosed or repeat testers who were previously diagnosed. We calculated the cost to identify one newly-diagnosed case, comparing results for screening in healthcare settings with targeted testing in CBOs.

Results: In 2006, 30,211 HIV tests were conducted by NYCDOHMH-funded programs, yielding 443 cases. Routine screening yielded 23,963 tests and identified 360 cases. Targeted testing yielded 6,258 tests and identified 83 cases. 59% of cases identified through screening were newly diagnosed, compared with 64% of cases identified through targeted testing. Median cost to identify one newly-diagnosed HIV case through routine screening and through targeted testing was $9,021 (range: $4,968–$23,283) and $47,189 ($5,863–$77,184), respectively.

Conclusions: Cost to identify one newly-diagnosed HIV case is lower through routine screening in healthcare settings than through targeted testing in CBOs. However, some CBOs using targeted testing are as effective in identifying newly-diagnosed cases as some hospitals using routine screening.