BMJ  2006;333:1265 (16 December), doi:10.1136/bmj.39059.380961.80

Practice

Short cuts

Routine HIV screening can be cost effective

The US Centers for Disease Control and Prevention (CDC) recently recommended voluntary HIV screening for all adults and adolescents accessing health care. The US is the first industrialised nation to shift from targeted screening based on risk to routine screening, and at least one study shows it could be cost effective.

HIV screening helps infected people by getting them treatment that slows the progress of disease. Its effects on transmission are less clear, however. Screened and treated people are less infectious, but they are infectious for longer, and they risk becoming complacent about safe sex. If we assume that screening and treatment help slow the spread of HIV, then the study's authors estimate that routine one off screening with a rapid HIV test would be cost effective in populations with a prevalence of undiagnosed infections greater than 0.2%. That is, screening would cost less than $50 000 for each quality adjusted life year saved. Screening remained cost effective even if it increased the spread of disease, but only at the slightly higher prevalence of 0.4%.

The authors and a linked editorial (pp 857-9) both support the CDC's new recommendations, and the authors suggest that doctors should find out the prevalence of undiagnosed HIV in their area so they can comply.

References

Ann Intern Med 2006;145:797-806[Abstract/Full Text] Ann Intern Med 2006;145:857-9[Full Text]

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