Is the CDC's Universal Testing Plan Off the Mark?

A targeted campaign of testing and counseling aimed at people who are at high risk for HIV would be more effective than the mass patient-screening proposed by the Centers for Disease Control and Prevention, according to an analysis by David Holtgrave, Ph.D., professor and chair of the Johns Hopkins Bloomberg School of Public Health. Holtgrave's study examined the cost-effectiveness of the CDC's testing plan and was published in the June 2007 edition of the journal PLoS Medicine. Holtgrave has determined that the CDC's strategy is likely to cost $864 million for one year. Using standard methods of cost-effectiveness analysis, he estimates that for the same cost a program of targeted counseling and testing would diagnose 188,170 new HIV infections, compared with 56,940 that would be detected through the CDC's testing plan. Additionally, targeted counseling and testing would prevent an estimated 14,553 new HIV infections at a cost of $59,383 per infection prevented, compared to 3,644 from opt-out testing at a cost of $237,149 per infection prevented. 'It is important that all people living with HIV know their serostatus so that they might access lifesaving HIV treatment,' Holtgrave says. 'The question now is to determine the most effective testing strategies for identifying people with HIV.'