Researchers led by José Moltó evaluated the epidemiologic and economic impact of implementing a human immunodeficiency virus (HIV) screening protocol in hospital emergency departments (ED) in the context of current clinical practices in Spain. Their study, published in Emergencias, concluded that a protocol for targeted screening of individuals with circumstances that suggest higher risk for HIV infection could “increase diagnoses, avert new infections, and generate savings in comparison with screening practices currently in effect.”
The study’s collaborators estimated the overall incidence of HIV infections and their associated costs in Spain over a 20-year period based on a model of various health states which represent different risks for HIV transmission. The estimated impact of a targeted screening protocol for persons in the ED with factors suggestive of HIV risk, including diagnosis of a sexually transmitted infection, mononucleosis, herpes zoster infection, community-acquired pneumonia, practice of chemsex (defined as intentional sex under the influence of psychoactive narcotics), and post-exposure prophylaxis need, was compared to current clinical practice in Spain, which has no established HIV screening protocol.
According to the authors, implementing a protocol to screen all persons in hospital EDs who have one or more of the described circumstances would require an initial investment of €20 million over 20 years, but would prevent 13,615 new HIV infections, for an estimated 20.6% reduction in incidence compared to the current diagnostic approach. The authors further estimated that the reduction in HIV infection incidence could potentially save the health system €4,411 million over 20 years, for a return of €224 per euro invested.
Economic analysis ultimately supported the authors’ theory that a targeted screening protocol for HIV infection would reduce the overall incidence and be an economically effective strategy for the health system in Spain.