ArticlePloS one2011
HIV screening via fourth-generation immunoassay or nucleic acid amplification test in the United States: a cost-effectiveness analysis.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Evaluating the Evidence for More Frequent Than Annual HIV Screening of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From a Systematic Review and CDC Expert Consultation.Public health reports (Washington, D.C. : 1974)Pooled it
- Trial
- Distinguishing active HIV-1 infection from vaccine-induced seropositivity in HIV vaccine trial participants.Science advances · 2025Article
- Cost-Effectiveness of HIV Prevention Strategies: A Systematic Review of Economic Evaluations.HIV/AIDS (Auckland, N.Z.) · 2025Review
- Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review.International journal of environmental research and public health · 2022Article
- The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review.AIDS and behavior · 2022Article
- Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2018Article
- p24 revisited: a landscape review of antigen detection for early HIV diagnosis.AIDS (London, England) · 2018Review
- Improving the Quality of Diagnostic Studies Evaluating Point of Care Tests for Acute HIV Infections: Problems and Recommendations.Diagnostics (Basel, Switzerland) · 2017Article
- Cost-Effectiveness of Frequent HIV Testing of High-Risk Populations in the United States.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Ten Years of Screening and Testing for Acute HIV Infection in North Carolina.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Optimizing Human Immunodeficiency Virus Testing Interventions for Men Who Have Sex With Men in the United States: A Modeling Study.Open forum infectious diseases · 2015Article
- Enhanced Sensitivity for Detection of HIV-1 p24 Antigen by a Novel Nuclease-Linked Fluorescence Oligonucleotide Assay.PloS one · 2015Article
- Performance of a redesigned HIV Selectest enzyme-linked immunosorbent assay optimized to minimize vaccine-induced seropositivity in HIV vaccine trial participants.Clinical and vaccine immunology : CVI · 2014Article
- Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver, British Columbia.AIDS (London, England) · 2013Article
- Real-life evaluation of a human immunodeficiency virus screening algorithm using a single combined p24 antigen-antibody assay.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2013Article
- Cost savings associated with testing of antibodies, antigens, and nucleic acids for diagnosis of acute HIV infection.Journal of clinical microbiology · 2012Article
- Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.PloS one · 2012Article
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAt least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation immunoassay tests.
methodsUsing a dynamic HIV transmission model instantiated with U.S. epidemiologic, demographic, and behavioral data, I estimated the number of acute infections identified, HIV infections prevented, quality-adjusted life years (QALYs) gained, and the cost-effectiveness of alternative screening strategies. I varied the target population (everyone aged 15-64, injection drug users [IDUs] and men who have sex with men [MSM], or MSM only), screening frequency (annually, or every six months), and test(s) utilized (fourth-generation immunoassay only, or immunoassay followed by pooled NAAT).
resultsAnnual immunoassay testing of MSM reduces incidence by 9.5% and costs <$10,000 per QALY gained. Adding pooled NAAT identifies 410 AHI per year, prevents 9.6% of new cases, costs $92,000 per QALY gained, and remains <$100,000 per QALY gained in settings where undiagnosed HIV prevalence exceeds 4%. Screening IDUs and MSM annually with fourth-generation immunoassay reduces incidence by 13% with cost-effectiveness <$10,000 per QALY gained. Increasing the screening frequency to every six months reduces incidence by 11% (MSM only) or 16% (MSM and IDUs) and costs <$20,000 per QALY gained.
conclusionsPooled NAAT testing every 12 months of MSM and IDUs in the United States prevents a modest number of infections, but may be cost-effective given sufficiently high HIV prevalence levels. However, testing via fourth-generation immunoassay every six months prevents a greater number of infections, is more economically efficient, and may obviate the benefits of acute HIV screening via NAAT.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.