Drug and Alcohol Dependence 2013;128(1-2):90-97. [doi: 10.1016/j.drugalcdep.2012.08.009]
Bruce R. Schackman, PhD (Weill Cornell Medical College), Lisa R. Metsch, PhD (University of Miami Miller School of Medicine, FNA Node), Grant N. Colfax, MD (SF Department of Public Health, WS Node), Jared A. Leff, MS (Weill Cornell Medical College), Angela Wong (Massachusetts General Hospital), Callie A. Scott, MSc (Massachusetts General Hospital), Daniel J. Feaster, PhD (University of Miami Miller School of Medicine, FNA Node), Lauren K. Gooden, PhD, MPH (University of Miami Miller School of Medicine, FNA Node), Tim Matheson, PhD (San Francisco Dept. of Public Health, WS Node), Louise F. Haynes, MSW (Lexington/Richland Alcohol and Drug Abuse Council, SC Node), A. David Paltiel, PhD, MBA (Yale School of Management), Rochelle P. Walensky, MD (Massachusetts General Hospital).
This is the Results Article for CTN-0032-A-1. The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. This article reports on outcomes from ancillary investigation CTN-0032-A-1 ("Economic Analysis of HIV Rapid Testing in Drug Abuse Treatment Programs") in which the cost-effectiveness of three HIV testing strategies used in 12 community-based substance abuse treatment programs was evaluated: off-site testing referral, on-site rapid testing with information only, and on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%), and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Referral for off-site testing was found to be less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,400/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit.
Conclusions: A strategy of on-site rapid HIV testing offered with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio < $100,000/QALY. Policy makers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested. (Article (Peer-Reviewed), PDF, English, 2013)
Keywords: Community health services | Cost-effectiveness | CTN ancillary study results | CTN platform/ancillary study | HIV rapid testing | HIV/AIDS | Sexual risk behavior | Sexually transmitted diseases | Drug and Alcohol Dependence (journal)
Document No: 908, PMID: 22971593, PMCID: PMC3546145.
Submitted by CTN Dissemination Librarians, 9/19/2012.