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Johns B, Doroshenko O, Tarantino L, Cowley P. The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine. AIDS Behav 2017; 21:655-664. [PMID: 27654316 DOI: 10.1007/s10461-016-1554-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We estimate the number of HIV cases diagnosed, costs, and cost per HIV case detected associated with integrating HIV counseling and testing (HCT) into primary health care facilities in Ukraine. The study uses a difference-in-difference design with four districts implementing the intervention compared to 20 districts where HCT were offered only at specialized HIV clinics. There was a 2.01 (95 % CI: 1.12-3.61) times increase in the number of HIV cases detected per capita in intervention districts compared to other districts. The incremental cost of the intervention was $21,017 and the incremental cost per HIV case detected was $369. The average cost per HIV case detected before the intervention was $558. Engaging primary health care facilities to provide HCT is likely desirable from an efficiency point-of-view. However, the affordability of the intervention needs to be assessed because expansion will require additional investment.
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Affiliation(s)
- Benjamin Johns
- International Health Division, Abt Associates, Inc., 4550 Montgomery Avenue, Bethesda, MD, 20814, USA.
| | | | - Lisa Tarantino
- International Health Division, Abt Associates, Inc., 4550 Montgomery Avenue, Bethesda, MD, 20814, USA
| | - Peter Cowley
- International Health Division, Abt Associates, Inc., 4550 Montgomery Avenue, Bethesda, MD, 20814, USA
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Osorio G, Hoenigl M, Quartarolo J, Barger K, Morris SR, Reed SL, Lee J, Little SJ. Evaluation of opt-out inpatient HIV screening at an urban teaching hospital. AIDS Care 2017; 29:1014-1018. [PMID: 28114789 DOI: 10.1080/09540121.2017.1282106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients. In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.
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Affiliation(s)
- Georgina Osorio
- a Division of Infectious Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , USA.,b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Martin Hoenigl
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,c Division of Pulmonology, Department of Internal Medicine , Medical University of Graz , Graz , Austria.,d Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Jennifer Quartarolo
- e Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | | | - Sheldon R Morris
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Sharon L Reed
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,g Department of Pathology , University of California San Diego (UCSD) , San Diego , USA
| | - Joshua Lee
- h Department of Medicine , Stritch School of Medicine, Loyola University of Chicago , Maywood , USA
| | - Susan J Little
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
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Orkin C, Flanagan S, Wallis E, Ireland G, Dhairyawan R, Fox J, Nandwani R, O'Connell R, Lascar M, Bulman J, Reeves I, Palfreeman A, Foster GR, Ahmad K, Anderson J, Tong CYW, Lattimore S. Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. HIV Med 2016; 17:222-30. [PMID: 26919291 DOI: 10.1111/hiv.12364] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.
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Affiliation(s)
- C Orkin
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - S Flanagan
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - E Wallis
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - R Dhairyawan
- Sexual Health Department, Barking, Havering and Redbridge NHS Trust, London, UK
| | - J Fox
- Sexual Health Department, Kings College Hospital, London, UK
| | - R Nandwani
- Sexual Health Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R O'Connell
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - M Lascar
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - J Bulman
- Sexual Health Department, Leeds Teaching Hospital, Leeds, UK
| | - I Reeves
- Sexual Health Department, Homerton University Hospital, London, UK
| | - A Palfreeman
- Sexual Health Department, University Hospital of Leicester NHS Trust, Leicester, UK
| | - G R Foster
- Hepatology Department, Queen Mary University London, London, UK
| | - K Ahmad
- Emergency Department, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - C Y W Tong
- Virology Department, Barts Health NHS Trust, Royal London Hospital, London, UK
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Tang W, Han L, Best J, Zhang Y, Mollan K, Kim J, Liu F, Hudgens M, Bayus B, Terris-Prestholt F, Galler S, Yang L, Peeling R, Volberding P, Ma B, Xu H, Yang B, Huang S, Fenton K, Wei C, Tucker JD. Crowdsourcing HIV Test Promotion Videos: A Noninferiority Randomized Controlled Trial in China. Clin Infect Dis 2016; 62:1436-1442. [PMID: 27129465 PMCID: PMC4872295 DOI: 10.1093/cid/ciw171] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/04/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Crowdsourcing, the process of shifting individual tasks to a large group, may enhance human immunodeficiency virus (HIV) testing interventions. We conducted a noninferiority, randomized controlled trial to compare first-time HIV testing rates among men who have sex with men (MSM) and transgender individuals who received a crowdsourced or a health marketing HIV test promotion video. METHODS Seven hundred twenty-one MSM and transgender participants (≥16 years old, never before tested for HIV) were recruited through 3 Chinese MSM Web portals and randomly assigned to 1 of 2 videos. The crowdsourced video was developed using an open contest and formal transparent judging while the evidence-based health marketing video was designed by experts. Study objectives were to measure HIV test uptake within 3 weeks of watching either HIV test promotion video and cost per new HIV test and diagnosis. RESULTS Overall, 624 of 721 (87%) participants from 31 provinces in 217 Chinese cities completed the study. HIV test uptake was similar between the crowdsourced arm (37% [114/307]) and the health marketing arm (35% [111/317]). The estimated difference between the interventions was 2.1% (95% confidence interval, -5.4% to 9.7%). Among those tested, 31% (69/225) reported a new HIV diagnosis. The crowdsourced intervention cost substantially less than the health marketing intervention per first-time HIV test (US$131 vs US$238 per person) and per new HIV diagnosis (US$415 vs US$799 per person). CONCLUSIONS Our nationwide study demonstrates that crowdsourcing may be an effective tool for improving HIV testing messaging campaigns and could increase community engagement in health campaigns. CLINICAL TRIALS REGISTRATION NCT02248558.
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Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine
| | - Larry Han
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - John Best
- University of North Carolina Project-China
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine, University of California, San Francisco
| | - Ye Zhang
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Katie Mollan
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Julie Kim
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Fengying Liu
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Michael Hudgens
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Barry Bayus
- Business School, University of North Carolina at Chapel Hill
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine
| | - Sam Galler
- University of North Carolina Project-China
- University of Oxford, United Kingdom
| | - Ligang Yang
- Guangdong Provincial Center for Skin Diseases and STI Control
| | - Rosanna Peeling
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine
| | | | | | - Huifang Xu
- Department of HIV/AIDS Prevention and Control, Guangzhou Center for Disease Control and Prevention, Baiyun, China
| | - Bin Yang
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | - Shujie Huang
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
| | | | - Chongyi Wei
- School of Medicine, University of California, San Francisco
| | - Joseph D Tucker
- University of North Carolina Project-China
- Guangdong Provincial Center for Skin Diseases and STI Control
- Social Entrepreneurship for Sexual Health (SESH) Global, Guangzhou, China
- School of Medicine
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