Dr. David Holtgrave's Response to Drs. Branson and Janssen's comments on his article, Costs and Consequence of the U.S. Centers of Disease Control and Prevention's Recommendations for Opt-Out HIV Testing, PLoS Medicine (2007)

In his article, “Costs and Consequence of the U.S. Centers of Disease Control and Prevention’s Recommendations for Opt-Out HIV Testing,” Dr. Holtgrave concluded that targeted HIV testing with counseling is more cost-effective than the CDC-recommended routine “opt-out” testing. Drs. Branson and Janssen, the CDC officials most directly involved in the development of the agency’s current “opt-out” testing recommendations, criticized this conclusion for being based on mistaken assumptions about the diagnosis rates of routine testing at generalized healthcare facilities compared to the diagnosis rates and costs of targeting and testing high risk individuals. In response, Dr. Holtgrave points out that even if the estimated HIV prevalence rate among the targeted at-risk population is halved and one-third of the intervention’s funding is spent identifying populations to target rather than on testing, targeted testing with counseling remains more cost-effective.

While Dr. Holtgrave’s study did not compare the HIV detection rates of different testing interventions at actual healthcare facilities, he notes that data that Drs. Branson and Janssen reference from a recent study indicate that targeted testing with counseling in the emergency room setting has higher rates of test acceptance and HIV detection than routine “opt-out” testing. Missing from the study that Drs. Branson and Janssen referenced was information about the comparative costs of routine “opt-out” testing and targeted testing with counseling among the intervention sites.

“Costs and Consequence of the U.S. Centers of Disease Control and Prevention’s Recommendations for Opt-Out HIV Testing” is available in the Resource Bank here.