HIV Rapid Testing in a VA Emergency Department and Primary Care Department Setting: Cost Analysis at Five Years

Patients with HIV benefit from early diagnosis, however, the approach and cost of implementation of the HIV testing is often unknown. Thus, this study explored the implementation of the HIV oral rapid testing in the primary care setting and Emergency Department in the US Veterans Affairs Healthcare System.  We conducted a comprehensive cost-minimization analysis to comprehend the financial attributes of the first five years of these implementations wherein nurses  administered HIV oral rapid tests (RT) to patients in the ED and primary care setting.  Deidentified quantitative data was gathered from the electronic medical records detailing quarterly HIV rapid testing rates in the ED setting and primary care settings spanning the first five years. At five years, a total of 2,620 HIV RTs had been administered  in the ED and 2,117  in the primary setting. Despite quarterly variability in testing rates, regression analyses revealed an average longitudinal increase of 3.58 per quarter in the ED and a 2.6 quarter increase in primary care. Over the course of five years, we determined that the cost of HIV testing in primary care is estimated about $5,200 to $5,800, with a gradual increase in quarters 5 – 8.  We conclude that the implementation of HIV testing in primary care and ED is a cost effective approach to identifying patients with HIV. Over the course of this implementation, Veterans Health Administration (VHA) policy transitioned from written to verbal consent for HIV testing, serving to reduce the time, and cost(s) associated with the testing process.