176383 Cost of finding one newly-diagnosed HIV case in New York City

Monday, October 27, 2008: 2:30 PM

Benjamin W. Tsoi, MD, MPH , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
Vanessa Woog, MPH , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
Chitra Ramaswamy, MBBS, MPH , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
David B. Hanna, MS , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
Elizabeth Begier, MD, MPH , Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY
M. Monica Sweeney, MD, MPH , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
Blayne Cutler, MD, PhD , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY
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.

Learning Objectives:
1. List three approaches to HIV testing 2. Articulate the procedure for identifying a newly-diagnosed HIV case in New York City

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the administrator overseeing HIV testing programs funded by the New York City Department of Health and Mental Hygiene
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.