Identifying Persons Living with HIV Infection through Social Network HIV Testing – a Cost Effectiveness Analysis

Background: The authors compared the cost effectiveness of 3 HIV testing and counseling (HTC) scenarios: a social network HIV testing (SNT) research study, a hypothetical SNT program conducted outside the research setting, and conventional client-initiated and/or outreach-based HTC.

Methods: Outcomes and cost data were collected from research study records and key informant interviews. For each approach, the cost per HIV test and the cost per person living with HIV (PLHIV) identified were computed. Sensitivity analyses explored the effect of varying costs and effectiveness

Results:  Cost per HIV test was 340% greater in the SNT research study and 282% greater in the hypothetical SNT program compared to conventional HTC ($99.42, $82.44, and $29.22, respectively). However, cost per PLHIV identified was 39.7% less in the SNT research study and 50% less in the hypothetical SNT program than conventional HTC ($2,684.42, $2,225.79, and $4,450.46, respectively). The hypothetical SNT program could be roughly twice as costly as estimated (or half as effective) and remain more cost-effective than conventional HTC.

Conclusions:  Social network approaches to HTC are cost-effective strategies for identifying PLHIV and should be considered for wider implementation.