Estimating the Costs of Delivering HIV/STD Partner Services

Background: CDC guidelines recommend Partner Services (PS) for HIV and STDs such as syphilis, gonorrhea, and chlamydia. However, there is limited research on the costs and effort related to the delivery of HIV/STD PS in health department settings. 

Methods: Using a retrospective microcosting-staff allocation approach, fixed and variable program costs were collected from 2009-2011 in six regional offices in New York State undergoing HIV/STD field services program integration. Cost data was matched to PS outcomes data collected through statewide HIV and STD surveillance systems. All costs were adjusted for inflation and are presented in 2009 dollars. 

Results: As FTE effort on HIV/STD PS increased following the integration of HIV and STD field services staff, the average cost per PS index interview and per partner notification increased 61% ($654 to $1,054) and 83% ($854 to $1,564), respectively.  HIV cases constituted 4.8% of total PS assignments, with the cost per new HIV infection identified through HIV PS estimated at $21,863.  Syphilis cases accounted for 2.5% of PS assignments.  Based on case volume, the majority of PS program costs were allocated to chlamydia and gonorrhea diagnoses, which constituted 92.7% of total PS case assignments. 

Conclusions: Increased staff effort on HIV/STD PS following program integration resulted in higher costs per PS outcome. Results strongly suggest that PS for HIV is a cost-effective method of identifying new cases of infection, but the majority of program effort and related costs are spent on PS for chlamydia and gonorrhea.  More research is needed on the cost-effectiveness of partner services for STDs such as chlamydia and gonorrhea in order to better allocate limited public health resources.