Details:

Alternative Title:
J Adolesc Health
Publisher's site:
http://dx.doi.org/10.1016/j.jadohealth.2017.08.028
Personal Author:
Neilan, Anne M. ; Dunville, Richard ; Ocfemia, M. Cheryl Bañez ; Salomon, Joshua A. ; Francke, Jordan A. ; ... More +
Neilan, Anne M. ; Dunville, Richard ; Ocfemia, M. Cheryl Bañez ; Salomon, Joshua A. ; Francke, Jordan A. ; Bulteel, Alexander J.B. ; Wang, Li Yan ; Hsu, Katherine K. ; DiNenno, Elizabeth A. ; Walensky, Rochelle P. ; Parker, Robert A. ; Freedberg, Kenneth A. ; Ciaranello, Andrea L. Less -
Description:
Purpose

To assess the optimal age at which a one-time HIV screen should begin for adolescents and young adults (AYA) in the United States without identified HIV risk factors, incorporating clinical impact, costs, and cost-effectiveness.

Methods

We simulated HIV-uninfected 12-year-olds in the US without identified risk factors who faced age-specific risks of HIV infection (0.6–71.3/100,000PY). We modeled a one-time screen ($36) at age 15, 18, 21, 25, or 30, each in addition to current US screening practices (30% screened by age 24). Outcomes included retention in care, virologic suppression, life expectancy, lifetime costs and incremental cost-effectiveness ratios in $/year-of-life saved (YLS) from the healthcare system perspective. In sensitivity analyses, we varied HIV incidence, screening and linkage rates, and costs.

Results

All one-time screens detected a small proportion of lifetime infections (0.1–10.3%). Compared to current US screening practices, a screen at age 25 led to the most favorable care continuum outcomes at age 25: proportion diagnosed (77% vs. 51%), linked to care (71% vs. 51%), retained in care (68% vs. 44%) and virologically suppressed (49% vs. 32%). Compared to the next most effective screen, a screen at age 25 provided the greatest clinical benefit, and was cost-effective ($96,000/YLS) by US standards (<$100,000/YLS).

Conclusions

For US AYA without identified risk factors, a one-time routine HIV screen at age 25, after the peak of incidence, would optimize clinical outcomes and be cost-effective compared to current US screening practices. Focusing screening on AYA ages 18 or younger is a less efficient use of a one-time screen among AYA than screening at a later age.


Subjects:
[+]
Adolescence Adolescent Adult Article Child Cost-Benefit Analysis Female HIV Infections HIV Screening HIV Testing Human Immunodeficiency Virus Humans Male Mass Screening Quality-Adjusted Life Years Risk Factors United States Young Adult Young Adults
Source:
J Adolesc Health. 62(1):22-28
Pubmed ID:
29273141
Pubmed Central ID:
PMC5745059
Document Type:
Journal Article
Funding:
U38 PS004644/PS/NCHHSTP CDC HHSUnited States/ ; R01 AI110340/AI/NIAID NIH HHSUnited States/ ; R01 AI042006/AI/NIAID NIH HHSUnited States/ ; R01 HD079214/HD/NICHD NIH HHSUnited States/ ; L30 AI120123/AI/NIAID NIH HHSUnited States/ ; ... More +
U38 PS004644/PS/NCHHSTP CDC HHSUnited States/ ; R01 AI110340/AI/NIAID NIH HHSUnited States/ ; R01 AI042006/AI/NIAID NIH HHSUnited States/ ; R01 HD079214/HD/NICHD NIH HHSUnited States/ ; L30 AI120123/AI/NIAID NIH HHSUnited States/ ; T32 AI007433/AI/NIAID NIH HHSUnited States/ Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:76c62b35c95c5dc452ee2cead43dfc3f9011b71e5e4ba92596da48e26f4f78aa
Download URL:
https://stacks.cdc.gov/view/cdc/50631/cdc_50631_DS1.pdf
File Type:

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