Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia.

BACKGROUND: The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. METHODS: A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. RESULTS: Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. CONCLUSIONS: This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.

Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care?

The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006-2008) and another with those diagnosed by rapid testing (2010-2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p < 0.001). In the conventional test group, the median period of time before the first consultation with an infectious disease specialist was 99 days, and for the rapid test group the time was 14 days (p < 0.001). The median time between the first blood sample and the first results of the CD4 count and viral load was approximately 2.5 times lower in the rapid test group (p < 0.001 for both). The median CD4 count in the rapid test group (472) was higher than in the conventional test group (397) (p = 0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.

Comparation of Pathogens in Infectious Gastroenteritis Cases Using Multiplex Ncleic Acid Amplification Testing and Conventional Laboratory Diagnostic Tools / 现代检验医学杂志

Objective To compare the performance of a commercial multiplex nucleic acid amplification test (MultiplexNAT) and the conventional microbiological testing for etiologic pathogens of gastroenteritis.Methods 135 stool specimens from 135 patients showing gastroenteritis symptoms were collected and detected by both the MultiplexNAT and the conventional testing.Results The detection rates of at least one potential etiologic agent was 81.5 ％ and 33.3％ by the MultiplexNAT and conventional testing,respectively.12 pathogens could be detected by the MultiplexNAT while 5 pathogens could be detected by the conventional testing.Of the negative samples from conventional testing,48.1％ were positive with the MultiplexNAT.Furthermore,31.1 ％ and none of the stool specimens showed coinfection by MultiplexNAT and conventional testing,respectively.Using MultiplexNAT,the positive detection rates of viruses were highest in the outpatient settings,emergency and inpatient settings,which were 15.6 ％,31.1 ％ and 3.7 ％ respectively.The overall proportion of pathogen-positive samples was higher for outpatient settings than for emergency and inpatient settings using both conventional testing and the MultiplexNAT.x2 test for paired data for statistical analysis:positive detection rates,coinfection positive detection rates and three settings positive detection rates using two methods was statistically significant respectively (x2 =45.57～58.887,P＜0.01).Conclusion The MultiplexNAT significantly has more postivie detection rates compared to the conventional testing,and could be a possible method in the diagnosis of infectious gastroenteritis diseases.