Reducing HIV infections in Hong Kong: a systematic review of the cost-effectiveness of expanded screening

Abstract

Background Routine voluntary HIV screening has been found to be cost-effective in regions with undiagnosed prevalence > 0.1%. However, a large proportion of infected patients are still unaware of their status and presenting to care late, leading to greater risk s for infection. As expanded ART has been shown to be highly effective in improving patient health and reducing HIV viral load, a strategy of expanded screening with earlier initiation of ART may be effective at reducing the numbers of new infections.

Aim A systematic review was carried out with the aim of understanding what drives the cost-effectiveness of expanded HIV screening at low prevalence rates. A thorough investigation of sensitivity analysis was done to determine if low prevalent regions can implement screening at good value for cost and how money should be spent to maximize benefits.

Methods An extensive literature review of studies published in English between 1996 and 2010 were identified from various electronic databases, included gray literature search and hand search. A qualitative assessment of the literature was undertaken.

Results Results of the analysis found that expanded screening can be cost-effective at undiagnosed prevalence rates below that of current recommendations. Factors of linkage to care, and benefits of reduced secondary transmissions through reduced risk behaviors had the most impact on models. Screening while maximizing benefits due to linkage to care and secondary transmissions can may be appropriate for low prevalence regions such as Hong Kong, however further analysis would be necessary.