The Cost-Effectiveness of Expanded Testing for Primary HIV Infection

The authors note early in the article some of the problems that make it difficult to target testing to patients who are likely to have primary HIV infection (PHI). For instance, physical symptoms are similar to influenza, and not specific to PHI. The authors also point out that it is “difficult to determine who has a high probability of primary HIV infection when evaluating risk factors alone,” and that health care workers may fail to ask about risk factors. In fact, a closer examination of these barriers to targeted testing may reveal a solution.

While risk factors alone may not provide sufficient information for targeting, the authors estimate of the cost effectiveness of targeting testing to patients with specific viral symptoms and *at least one risk factor* improved by about 33% compared to targeting only on the basis of specific viral symptoms ($23,000 vs. $35,000). Additionally, although the authors indicate that “some patients may be unaware of their risky behavior,” a more accurate statement is that some patients may be *unaware that their behaviors are risky.* The is an important distinction because it means that training health care workers to ask about specific behaviors rather than “HIV risk” would likely improve our ability to identify patients more likely to have PHI, and to more [cost] effectively target testing and prevention efforts. Indeed, it is likely to be a cost effective prevention measure in itself to educate a patient who is unaware that their behaviors are putting them at risk for HIV, even if they are not currently seroconverting.

An important point not made in this article is that, in this time of limited resources, it is not enough to determine if a program or policy is “cost effective” according to some arbitrary standard. In order to effectively utilize limited resources, what we must ask is, which policy is MOST cost effective?

Competing interests:   None declared