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F Spielberg1, S Jackson1, B Varghese2,
B Branson2, SD Reed1, G Goldbaum1,3,
SD Sullivan1
University of Washington, Seattle, WA2;, CDC3;
Public Health – Seattle & King County
Background: The HIV Alternative Testing study showed that needle
exchange (NE) and bathhouse (BH) clients prefer rapid and oral fluid
HIV testing, and are more likely to receive their results under these
testing methods as compared.
Objectives: Calculate the costs of alternatives for HIV testing
at an NE and two BHs for gay men in Seattle.
Methods: Four testing strategies were offered to a total of
18,089 people. One testing strategy was randomly assigned to the sites
each day. The strategies were as follows: 1) Standard blood HIV testing,
with counseling and a return visit for results; 2) Rapid testing with
SUDS; 3) Standard oral fluid HIV testing; and 4) Standard HIV testing
with the option of written materials for counseling. Time flow studies
assessed the resources necessary for each strategy. Measures of effectiveness
were acceptance of testing and receipt of results. We analyzed (from
the provider perspective) the cost per test result received.
Results: At the BHs, rapid testing was more effective for receipt
of results (157 per 1000 offered) and less costly ($75 per result received)
than oral fluid testing (124, $112), or standard testing, with (82,
$130) or without (92, $118) the counseling option. At the NE, oral
fluid testing (71, $155) was most effective, but rapid testing (65,
$136) was less costly. Both were more effective and less costly than
standard testing, with (51, $175) or without (27, $318) the counseling
option. In sensitivity analysis, if oral fluid testing cost less than
$12, it would be more cost-effective than rapid testing at the NE.
Conclusions: Fewer clients learned their HIV status with standard
HIV testing than with rapid or oral fluid testing at both the NE and
BHs. Standard HIV testing was also most costly.
Implications for Programs/Policy. With
rapid or oral fluid testing, considerably more persons at high risk
learn their HIV status, at a lower cost than with the current standard
HIV testing process.
Presented at the 2002 National STD Prevention Conference, March 4-7,
2002, San Diego, CA.
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