Routine vs. Targeted HIV Screening: Costs and Consequences

The question of whom to test for HIV infection is controversial. The CDC urges routine HIV screening on an “opt-out” basis for all persons aged 13–64 in all healthcare settings. By contrast, the United States Preventive Services Task Force (USPSTF) recommends screening only for persons at increased risk for such infection. To inform this debate, a researcher has estimated overall implementation costs and secondary HIV transmissions averted under four testing scenarios: (1) opt-out testing — a base case intended to emulate the CDC recommendations; (2) opt-out testing assuming some behavioral disinhibition; (3) opt-out testing in conjunction with routine prevention counseling; and (4) counseling and testing targeted to high-risk patients. Inp…