Testing High-Risk Groups Best Strategy for HIV Diagnosis

'Opt-out' screening of general population less effective than targeted testing

WEDNESDAY, June 13 (HealthDay News) -- Targeted HIV screening for high-risk populations is a more effective method of diagnosing and preventing the spread of the disease than population-wide screening without risk assessment and counseling, according to a report published in the June issue of the open access journal PLoS Medicine.

David R. Holtgrave, Ph.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, estimated the overall costs and consequences of the recommendation by the U.S. Centers for Disease Control and Prevention for opt-out HIV testing of all people in the United States, aged 13 to 64, who are seen within the health care system, and compared these with the outcomes of targeted counseling and testing.

Assuming equal costs of $864,207,288 and a 1 percent HIV seropositivity rate, targeted counseling and testing would diagnose 188,170 infections over a one-year period, versus 56,940 for opt-out testing. The former strategy would prevent 14,553 HIV infections versus 3,644 for the latter, and would lower the gross cost per infection ($59,383 versus $237,149), the report indicates.

"My analyses indicate that even when HIV seropositivity rates are as low as 0.3 percent, targeted counseling and testing performs better than opt-out testing on several key outcome variables. These analytic findings should be kept in mind as HIV counseling and testing policies are debated in the United States," the author concludes.

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