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Broad HIV Screening Valuable Even in Communities with Low Infection Rates

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Science Update

An HIV/AIDS screening program may be cost-effective even in communities where the infection rate and the prevalence of the disease are very low and among populations at low risk for HIV infection, according to an NIMH-funded study published December 5, 2006, in the Annals of Internal Medicine.

Any given community must decide if a wide-reaching HIV screening program is beneficial and cost-effective, based on how common the disease is (prevalence) within the community and the annual rate at which new cases are reported (incidence rates). Until very recently, guidelines from the Centers for Disease Control and Prevention (CDC) had recommended that a community implement an HIV screening program if it has a 1 percent prevalence rate, but opinions differ as to whether this threshold is optimal.

Using a simulated model, David Paltiel, Ph.D., of Yale University and colleagues found that a one-time, rapid-test HIV screening program appears to be economically advantageous even in communities with a prevalence rate of only 0.28 percent of the population and an annual incidence rate of 0.03 percent. The results also suggest that repeat screening for the disease every five years is similarly valuable for communities with prevalence rates as low as 0.45 percent and annual incidence rates as low as 0.0075 percent.

"A community-wide HIV screening program can detect and treat more HIV infections in their early stages, which can have a positive impact on quality of life and improve life expectancy rates," said Dr. Paltiel. "Compared with other screening programs for diseases such as breast cancer or high blood pressure, HIV screening pays a better return on a community's investment." he added.

According to the CDC, about 25 percent of the more than 1 million Americans living with HIV are not aware that they are infected. The agency now recommends that HIV testing be routine for all U.S. residents ages 13 to 64 in all health care settings regardless of risk or prevalence rates, and issued revised community screening guidelines  on September 22, 2006. This study provides practical guidance for determining new screening thresholds.

Paltiel AD, Walensky RP, Schackman BR, Seage GR, Mercincavage LM, Weinstein MC, Freedberg KA. Expanded HIV Screening in the United States: Effect on Clinical Outcomes, HIV Transmission, and Cost. Annals of Internal Medicine. 5 Dec 2006 145(9).