Ellen Eaton, MD, is Assistant Professor in the UAB Division of Infectious Diseases, a 2017-2019 Fellow of the National Academy of Medicine, and a UAB PCOR K12 Scholar with an interest in HIV/STI health outcomes and policy. Her current research evaluates patient preferences related to HIV treatment options and the use of decision analyses to compare the effectiveness of HIV treatments and STI testing strategies. Dr. Eaton recently conducted a study looking at the budgetary impact of compliance with STI Screening Guidelines in Persons Living with HIV. This work was presented as an oral presentation at the 2016 annual ID week in New Orleans, LA and recently published in the Journal of Acquired Immune Deficiency Syndrome (JAIDS). Dr. Eaton is currently preparing a K23 submission to NIH.


Introduction. The 2015 Centers for Disease Control (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines recommend annual screening of all persons living with HIV (PLWH) for N. gonorrhoeae, C. trachomatis, and syphilis; annual T. vaginalis screening is recommended for HIV-infected women. The study objective is to evaluate the budgetary impact of sexually transmitted infection (STI) screening. We hypothesized that recommended STI screening is costly and would not be covered in full by insurers.

Methods. This cost analysis evaluates charges and reimbursement for recommended screening for the above 4 STIs. This study projects the net yield (reimbursement minus expenditures) of providing tests to eligible PLWH receiving care at an urban HIV clinic in Birmingham, AL. Four scenarios evaluated the net yield when different laboratory providers, rates of compliance, and Ryan White Program fund availability were examined.

Results. The number of patients receiving care at our HIV clinic from August 2014 to August 2015 was 3,163 (768 female, 2,395 male). Annual screening for N. gonorrhoeae, C. trachomatis, syphilis, and T. vaginalis would lead to a mean net loss of $129,416, $118,304, $72,625, and $13,523, respectively. Most costly scenarios for a health system include the use of a regional laboratory (-$1,241,101) and lack of Ryan White HIV/AIDS Program funding (-$85,148).

Discussion. Compliance with STI screening practices is costly. Sustainability will require critical analysis of true costs and cost effectiveness of STI screening tests in PLWH. Providers, policy makers and insurers each have a role in ensuring the provision of these evidence-based services to PLWH.

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