Expanded HIV screening can increase patient life span, prevent the spread of the disease, and is cost effective, researchers at Yale, Harvard and the Massachusetts General Hospital report in the February 10 issue of the New England Journal of Medicine (NEJM).
The study's findings are part of a two-paper series in NEJM on the value of expanded HIV screening in the United States. The Yale/Harvard study used different data and methods than another study by VA, Duke and Stanford researchers, yet both teams reached roughly the same conclusions.
"The publication of these papers represents a golden opportunity to jump-start the expansion of HIV testing services in the U.S.," said Yale lead author A. David Paltiel, associate professor of health and policy administration in the Department of Epidemiology and Public Health at Yale School of Medicine. "Our findings, coupled with those of our colleagues, firmly establish the great value of expanded screening."
Paltiel and his team developed a mathematical model of HIV screening and treatment to predict the costs and benefits of HIV counseling, testing and referral. They found that routine, voluntary HIV screening every three to five years is cost-effective by U.S. standards, in all but the lowest-risk populations. Frequent HIV screening in moderate-to-high-risk populations could produce life expectancy gains at costs that compare favorably to many commonly employed screening interventions in other chronic conditions, including breast cancer, colorectal cancer, diabetes and hypertension. Paltiel said that even in settings with HIV infection levels similar to the U.S. general population, one-time screening could deliver excellent return on investment.
"HIV is a severe disease that, left untreated, produces substantial morbidity and mortality," said Paltiel. "It has a long asymptomatic phase, which can be diagnosed using very effective, inexpensive tests. Most importantly, early detection speeds linkage to proven, life-prolonging care and effective counseling to prevent further transmission."
Rochelle Walensky, assistant professor of medicine at Harvard and a co-author of the study, added, "The HIV epidemic is no longer confined to a handful of easily identifiable risk groups, yet current approaches to HIV testing are still focused on these sub-populations. The result is that 280,000 Americans with HIV remain unaware of their infection. Efforts to promote and finance routine, population-based HIV screening should be pursued aggressively."
Douglas K. Owens, M.D., of the VA Palo Alto Health Care System, and his team at the VA, Stanford and St. Michael's Hospital in Toronto, led another study in NEJM, which strongly supports Paltiel's findings. They developed a computer model to estimate the health benefits and expenditures of performing voluntary HIV screening programs in health care settings. They also found that screening for HIV infection is cost-effective relative to other commonly accepted screening programs and medical treatments.
Referring to the Yale/Harvard findings, Owens said, "It's exciting that a completely independent analysis had the same findings as we did. Both of these studies show that screening is life-prolonging and affordable."
The Yale/Harvard study was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, and the United States Centers for Disease Control and Prevention.
Other authors on the study included Milton C. Weinstein and George R. Seage III of Harvard School of Public Health; Kenneth A. Freedberg of the Massachusetts General Hospital, Harvard School of Public Health and Boston University School of Public Health; April D. Kimmel and Hong Zhang of the Massachusetts General Hospital and Harvard Medical School; and Elena Losina of Boston University School of Public Health.
Citation: NEJM, Vol. 352, Number 6, February 10, 2005.
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