Researchers call for GP-based HIV screening

A mathematical model developed through collaborative research has evaluated the data from RHIVA2 – a randomised controlled research trial done in Hackney, London. This has shown that the introduction of rapid finger prick GP-based screening of HIV during patient registration in the 74 high HIV prevalence boroughs in England is cost-effective and potentially cost-saving.

Researchers from the Queen Mary University of London (QMUL) and the London School of Hygiene & Tropical Medicine carried out the trial, and analysed the resulting data with help from a mathematical model from the Mathematics Institute & School of Life Sciences at the University of Warwick. The model, co-developed by Professor Deidre Hollingsworth at the University of Warwick, calculated the costs of screening and evaluated the costs, benefits and cost-effectiveness of this intervention.

The model, co-developed by Professor Deidre Hollingsworth at the University of Warwick, calculated the costs of screening…

Hackney is one of the London boroughs with a HIV prevalence of 8 infections per 1000 adults, and has been used as a reference in determining the severity of HIV occurrence in other areas across the country. The estimated cost of rolling out screening in 11 boroughs with Hackney-level HIV prevalence is £600,000, with the figure increasing to four million pounds if all 74 high HIV prevalence boroughs are screened. In accordance with criteria from the National Institute of Health and Care Excellence (NICE), this study has proven that the screening practice becomes cost-effective in 33 years. Some scenarios in Canada, however, indicate that the cost of health care and late diagnosis of HIV is greater than the cost of early diagnosis. This means that the HIV screening process could even become cost effective in just 13 years if this is also true for England.

Dr Rebecca Baggaley, lead author of the study, stated that: “Currently NICE uses a threshold of £20,000 to £30,000 per Quality Adjusted Life Year (QALY) gained to gauge whether the health benefits of an intervention offer value for money to the NHS and its patients. ‘QALY’ is a widely-used measure of health that combines length and quality of life. We found that over 40 years, primary care-based HIV screening in high prevalence areas would cost an estimated £26,626 per QALY gained and therefore warrants funding in the UK.”

The HIV screening process could even become cost effective in just 13 years…

Due to these results, researchers are now calling on the health care commissioners to introduce screening in GP surgeries in the 74 high-risk boroughs in England. Dr Werner Leber from QMUL said, “This is an important finding given today’s austerity. Financial pressures, particularly within local authority’s public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.” Early diagnosis of HIV could reduce morbidity, mortality and reduce transmission. This is because receiving effective treatment are less infectious to others where currently 18,000 people in the UK remain unaware that they are HIV positive.

There are, however, a few drawbacks to the results. The analysis of the data only took into consideration the costs directly incurred by the NHS and not the overhead costs. Additionally, some data such as the probability of transmission of the infection is based on international literature therefore might not accurately reflect the situation in Hackney, and consequently the rest of the UK. Nevertheless, research such as this can hopefully only improve the rate at which HIV is diagnosed, and by doing so reduce transmission of the disease.