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Background: Previous studies indicate feasibility and acceptability of HIV PS, yet HIV PS has not been widely disseminated nor adopted. While effective targeting HIV testing to high risk populations, no evaluation of HIV PNS program costs or effectiveness had been conducted.
Objectives: Determine annual costs and cost-saving/cost-effectiveness thresholds of PS within City Clinic, San Francisco’s sole municipal STD clinic.
Methods: Cost and threshold analyses per client/client contact were conducted from both payer and societal perspectives. Sensitivity analyses were conducted with program costs set to actual cost of STD program activities (3% of total costs- piggy-backed upon the STD PS program), and estimated at 30% of total program costs. All model inputs were estimated from the City Clinic’s data on HIV PS and other local data where available; cost-effectiveness was estimated at $50,000 or less per QALY saved.
Results: Annual HIV PS costs were approximately $400,000 which resulted in a cost per client of nearly $6,000. HIV PS annual costs at 30% were approximately $1.1 million, with a cost per client of nearly $16,000. At 3% and 30% programs, respectively, PS would be considered cost-effective (societal perspective) if 0.5 or 1.4 HIV infections were averted each year, and cost-saving if 1.75 or 4.6 HIV infections were averted per year, a highly attainable target as up to 50% of PS clients unaware of their HIV positive sero-status.
Conclusions: With a conservative estimate of PS annual service provision, the HIV PS program is highly cost-effective and cost-saving at low performance thresholds. The addition of HIV PS to the existing menu of services offered at STD clinics may be an effective and resource efficient public health intervention. Implications for Programs, Policy, and Research: HIV partner notification services can be both cost-effective and cost-saving, and can easily be incorporated into other STD service provisions.