# Presentation: 682873

## Economic evaluation of the HIV counseling and testing program at Hampden County Correction Center (HCCC)

- Beena Varghese, PhD
- Division of HIV/AIDS Prevention, CDC
- CDC: TA Peterman,  C Mugalla, K Irwin, T Gift
- HCCC: T Lincoln, T Conklin, A Miller, J Vivian, and HIV VCT staff

## Background

- Limited resources and competing priorities
- Economic evaluation tools can:
- Quantify the costs and benefits of a program, especially prevention programs
- Guide resource allocation
- HIV counseling and testing (CT) program at HCCC is one of the many health care programs for inmates

## BackgroundHIV CT program

- Well established and functional
- Standard testing (EIA & WB)
- Most of the eligible inmates (sentenced & who stay > 2 weeks) get tested
- Drug use or sexual exposure was main risk

## Objective

- Estimate the cost of CT program to detect a newly identified HIV case
- Model the cost-effectiveness of CT program compared to no program in preventing HIV

## Methods – Data Sources

- From January 1 – December 31, 2000
- Annual cost data (HCCC)
- Labor (wages adjusted for % time on CT)
- Material (phlebotomy related)
- Laboratory (charges for HIV tests)
- Other costs (biohazard waste disposal)
- Test data (Massachusetts Dept. of Public health, MDPH)
- Inmate demographics & risk behavior
- Test results

## Methods – Data Sources

- Effectiveness data (literature)
- Decision model (Varghese 2001)
- Adjusted for prior knowledge of serostatus (41%)
- Reduction in annual risk for HIV due to CT
- 25% for infected inmates (from 7% to 5.2%)
- 10% for uninfected inmates (from 0.3% to 0.27%)

## Decision Tree: Effectiveness of HIV CT Program

## HIV CT Program:Test data(Calendar year 2000)

- Number of HIV tests: 1192
- Number positive: 16
-  previously negative or unknown: 14

## HIV CT program: Direct Annual Costs*

- * Fixed costs of facility and overhead costs are not included

## Effectiveness of HIV CT program at HCCC

- Newly identified HIV positive cases: 14
- Annual risk of HIV infection: 7%
- Reduction in risk due to CT: 25%
- Cases prevented:14 x 7% x 25% = 0.25

## Effectiveness of HIV CT program at HCCC

- Inmates tested negative: 1176
- Risk of HIV acquisition: 0.3% (Kamb 1998)
- Reduction in risk due to CT: 10%
- Cases prevented:
- Benefits for only those previously untested (59%)
- 1176 x 59% x 0.3% x 10% = 0.21
- Benefits for all with Project RESPECT style counseling
- 1176 x 0.3% x 20% = 0.71

## Cost-effectiveness of HIV CT program for 1192 inmates at HCCC -Summary

## HIV CT program Summary

- Offered only to ~ 50% of inmates  (sentenced and who stay > 2 weeks)
- Costs $6071 per new HIV infection identified
- May avert 0.46 cases and would save societal dollars

## Limitations

- CE tools are best suited for comparisons of different programs
- Fixed and overhead costs not included
- Secondary cases from uninfected inmates  not included

## Discussion

- Despite frequent testing, new positives identified
- Increased focus on prevention?
- Risk-specific prevention?
- Client centered counseling of HIV negatives?
- Rapid testing (Increase testing)?
- Prevention for positives ?

## ConclusionsHIV CT program at HCCC

- Is effective in identifying new HIV cases
- Saves money for society in averted treatment costs
- Increased focus on prevention may be beneficial for both HIV positive and negative inmates
- Potential to increase testing with existing personnel