Public Health Investments in STD Clinics for HIV Testing: A Comparative Yield and Cost Effectiveness Analysis in Rhode Island

Background:  Public health departments are charged with identifying persons living with HIV (PLWA) who are unaware of their positive status.  Health departments traditionally invest in three strategies for HIV case finding, including: partner services, community-based screening in non-medical settings, and routine screening among STD clinic patients in specialty care clinical settings.  This project served to gain a better understanding of the yield and cost effectiveness of public health spending for HIV case finding in the Rhode Island state-sponsored STD specialty clinic as compared to partner services and community-based screening.

Methods: Data from 2012 - 2014 was obtained from the Rhode Island Department of Health that included HIV testing information (i.e., number of total tests and confirmed positive results) and public health spending for the three HIV case finding strategies.  This data was analyzed to determine which strategy had the highest positivity rates, cost per test conducted, and cost per new HIV infection diagnosed. 

Results: Compared with partner services and community based testing, HIV screening in STD clinical settings had the lowest cost per HIV case diagnosed ($5,446), the lowest cost per test ($34),  the highest number of HIV cases diagnosed (n=16) , and ranked second for HIV positivity (0.62%).  

Conclusions:  STD clinics can play an important role in public health efforts to help PLWA know their status and be linked to medical care.  In the case of Rhode Island, public health expenditures into STD clinics indicate that this strategy is the most cost-effective strategy for finding new HIV cases, especially because of their ability to leverage other sources of revenue (i.e., patient health insurance reimbursement).  With the goal of advancing “program collaboration and service integration” efforts, HIV and STD programs should consider the benefits of supporting STD clinics to achieve mutual public health goals.