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The optimal age for screening adolescents and young adults without identified risk factors for HIV
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1 2018
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Source: J Adolesc Health. 62(1):22-28
[PDF-483.93 KB]
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Alternative Title:J Adolesc Health
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Personal Author:
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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.
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Pubmed ID:29273141
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Pubmed Central ID:PMC5745059
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Funding:
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Volume:62
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Issue:1
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