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Free HIV tests cheaper than charging when goal is preventing AIDS

Offering free HIV tests instead of charging a small fee is more cost-effective at preventing HIV infections and draws in three times as many people for testing, according to a Duke University Medical Center study conducted in Tanzania.

The Duke researchers provided free HIV tests and counseling during a two-week pilot program in 2003. The number of people seeking tests increased from 4.1 per day before the free testing interval to 15.0 per day during the pilot program. However, the number decreased to 7.1 people per day after the small fee ?1,000 Tanzania shillings or 95 U.S. cents ?was reinstated. When only four people per day were tested at the clinic, it cost $170 to avert an HIV infection, the study showed. But when the testing rate jumped to 15 people per day, the price of preventing an HIV infection dropped to $92 each, even without the revenue from fees. The cost includes everything required to run a testing program ?staff salaries, laboratory supplies and test kits, utilities and office supplies.

The study results were so striking that the Duke researchers sought additional funding to continue free testing in partnership with a community-based AIDS service organization in Moshi, Tanzania, said lead author Nathan Thielman, M.D. They have since tested more than 4,000 people, he said.

The results appear in the January 2006 issue of the American Journal of Public Health. Funding was provided by Roche Laboratories; the National Institutes of Allergy and Infectious Diseases, part of the National Institutes of Health; and awards from the U.S. Department of State Fulbright Program to Nathan Thielman and Helen Chu.

"I think there is an important policy message here," said Thielman, an associate professor of infectious diseases and medicine at Duke University Medical Center. "Providing free HIV tests increases the number of clients presenting for evaluation and makes HIV prevention more cost-effective. We changed our practice because
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Source:Duke University Medical Center


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