ArticleFrontiers in public health2026
Epidemiological yield and cost-effectiveness of non-targeted community HIV screening in a low-prevalence district: a prospective quasi-experimental study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Objective: To evaluate the epidemiological yield, cost-effectiveness, and mechanisms of diagnostic cascade attrition of active, expanded community-based HIV screening in a low-prevalence region, and to contextualize the regional management burden. Methods: A prospective, non-randomized, quasi-experimental study was conducted (August-December 2025) across six demographically matched sub-districts. Three implemented active community screening (intervention); three maintained routine facility-based testing (control). A deduplicated dual-track database mapped the diagnostic cascade, supplemented by a 7-month longitudinal cohort to assess regional disease burden. Micro-costing determined fixed and variable costs from a health-system perspective. The Number Needed to Screen (NNS), Cost Per New Diagnosis (CPND), and Incremental Cost-Effectiveness Ratio (ICER) were calculated, supported by Propensity Score Matching (PSM), permutation tests, and deterministic sensitivity analyses. Results: Among 17,305 unique participants (intervention: 14,434; control: 2,871), the intervention expanded coverage in the 35-49 age cohort (35.0% vs. 25.5%, Conclusion: In epidemiologically saturated settings, non-targeted community screening yields profound diminishing marginal returns. Material incentives inadvertently capture previously diagnosed older males who undergo repeated testing, resulting in substantial resource redundancy rather than identifying occult infections. To optimize cost-effectiveness, public health strategies must implement digital pre-screening interception mechanisms and strategically reallocate funds toward key-population friendly services and peer-driven interventions.
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