CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: By focusing on CD4 measurements rather than HIV viral load, past ART policies missed opportunities to fully utilize the benefits of ART to improve quality-of-life and prevent HIV transmissions. Future HIV prevention strategies should consider focusing on viral load rather than CD4 criteria in order to cost-effectively maximize public health impact. 1113 Costs of Expanded HIV Testing in 4 EDs: Results FromHPTN 065 Bruce R. Schackman 1 ; Ashley A. Eggman 1 ; Jared A. Leff 1 ; Megan Braunlin 1 ; Bernard M. Branson 2 1 Weill Cornell Medical College, New York, NY, US; 2 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US Background: HPTN 065 sought to expand HIV testing of emergency department (ED) patients in Bronx, NY and Washington DC between 2011 and 2013. EDs expanded laboratory HIV testing using different processes, resulting in differences in testing costs. Methods: We conducted micro-costing studies of rapid-result laboratory HIV testing at 2 participating EDs in each jurisdiction in 2013 and compared results to hypothetical costs of an optimized implementation process. Laboratory HIV testing was conducted for ED patients requiring a blood draw for clinical reasons. Costs were estimated by directly observing and interviewing ED directors and staff to document process flows, time estimates, and labor and materials costs. We used national wage and fringe rates and local materials costs to determine the average cost (excluding overhead) per completed non-reactive and reactive HIV test in 2013 US dollars. The optimized process cost was calculated using 4 th generation laboratory HIV tests, Multispot confirmatory testing, and a) minimum time estimates for each process flow step, or b) minimum time estimates and lowest wage and materials costs. Results: Labor time estimates ranged from 7-25 minutes for non-reactive tests and laboratory test volume ranged from 410-500 tests per month. Estimated costs ranged from $17-$24 per completed non-reactive test and $89-$110 per completed reactive test (including confirmatory testing and initial linkage to HIV care activities). Optimized process flow costs were approximately 45% lower for non-reactive tests, primarily due to automating screening eligibility confirmation and ordering of HIV tests, and approximately 20% lower for reactive tests, primarily due to shortening of the time for delivering and documenting test results prior to linking the patient to care (see Table). Laboratory HIV Testing Costs for ED Patients (2013 US dollars)

Poster Abstracts

ED = emergency department Note: all costs are incremental. † if cost equals zero, step was automated with no incremental cost †† only one ED had a cost for this step; at all other EDs this step was integrated into the registration process with no additional labor time required

§ includes 4 th generation laboratory testing cost only §§ includes Multispot confirmatory testing cost only

Conclusions: Expanded laboratory HIV testing was implemented in 4 EDs at a cost of approximately $17-$24 per completed non-reactive test (before overhead). An optimized process could achieve additional cost savings, but would require investments in interfaces between laboratory and electronic medical records systems to further automate some process steps.

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CROI 2015