Is Point of Care Rapid-HIV Testing in New York City School-Based Health Centers Worthwhile? An Analysis of Cost, Benefit and Utility

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2014-04Author
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Abstract
Montefiore Medical Center provides medical care through 20 school-based health
centers, serving 56 New York City public schools in the Bronx. Amongst these are 13 school
campuses participating in the Point of Care Testing (POCT) Rapid-HIV program. This analysis
determines the cost, benefit and utility of the POCT OraQuick Advance HIV-1/2 Rapid Antibody
Testing (HIV-R) as compared to standard in lab testing (HIV-IL) in the New York City public
school system. Pre-analytic, analytic and post-analytic variables were considered. The cost
effectiveness of HIV-R as compared to HIV-IL was found to be dependent upon the personnel
performing and reviewing the test, volume of tests/month, and amount of time spent reviewing
results. When testing volume exceeded an average 20 tests/month, HIV-R was more cost
effective. Students received their HIV-R results within 27.3 min, but could wait several days to
receive their HIV-IL results due to scheduling issues. According to the EMR Database, 69.9% of
students receiving HIV-R testing came in for reproductive health reasons or HIV/STI screening.
Additionally, 66% of those tested were female and 34% male. Providers reported a dramatic
increase in consent rates when switching to HIV-R, with many students consenting when
learning of the test’s non-invasive nature.
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