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

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.