Rapid, On-site HIV Testing: Increases Life Expectancy and Is Cost-effective

January 30, 2013 • 0 comments • By Jacques Normand, Ph.D., Director, AIDS Research Program, National Institute of Drug Abuse, National Institutes of Health

Dr. Jacques Normand

Incorporating rapid HIV testing in drug treatment programs is both cost effective and increases life expectancy for an HIV-positive person, according to an NIH-funded study published in September 2012 in the journal of Drug and Alcohol Dependence

. This study expands upon a previous finding of the National Drug Abuse Treatment Clinical Trials Network Rapid HIV Testing and Counseling Study that showed that onsite rapid HIV testing in substance abuse treatment programs correlated with increased receipt of HIV test results. (See Dr. Ron Valdiserri’s earlier blog post on this study.)
The study used a computer simulation model to project life expectancy, lifetime costs, and quality-adjusted life years (QALY’s) for HIV infected individuals. The model projected that the life expectancy for an HIV-positive person engaged in substance abuse treatment who is unaware of his/her HIV infection is 17.1 years with no intervention. The model calculated that referring these patients to clinics outside of the substance abuse treatment facility for HIV testing would increase life expectancy to 17.9 years, while offering onsite rapid HIV testing with a description of the testing procedure (that is, providing information only) would increase life expectancy to 20.8 years.
Providing rapid HIV testing in drug treatment programs is also a good investment of health care dollars. This study demonstrated that providing onsite rapid HIV testing was cost-effective using the Cost Effectiveness of Preventing AIDS Complications (CEPAC) model, taking into account various patient demographics including CD4 cell counts, viral burden (HIV RNA level), ART therapy regimen, presence of an acute AIDS-defining illness, etc. as well as the costs for medical treatment (DHHS, 2011).
Substance abuse places individuals at great risk for contracting HIV through the risky behaviors it engenders—behaviors that extend far beyond injection drug use. Treating HIV infection with today’s effective antiretroviral therapy not only improves the quality of life for those living with HIV, but it also reduces transmission to others. But effective treatment cannot begin until an infection is identified, which is why implementing HIV testing in centers where vulnerable populations — such as persons with substance use disorders — seek treatment can be so valuable. In fact, NIDA is investing heavily in this area to optimize ways to reach vulnerable populations (Seek), test them for HIV (Test), link those who test positive to the care they need (Treat), and develop services to help them maintain their treatment regimens (Retain).
For more information on how to implement rapid HIV testing in a variety of treatment settings, please visit the website on the NIDA/SAMHSA Blending Initiative for a compilation of resources on rapid HIV testing.