Measure the costs of late HIV diagnosis

Mara Ruiz
Mara Ruiz

Diagnosing a person with HIV very late is much more expensive in the medium term than detecting the virus in a timely manner. According to a study conducted in the Netherlands, it would cost 246% more to treat someone with an advanced infection.

The research analyzed data from the ATHENA cohort, a collection of information that is fed daily from the 27 specialized HIV clinics that that European nation has.

According to what the Working Group on HIV Treatments (wGt-HIV) reports, the Netherlands requires all its inhabitants to pay for basic health insurance, which allows care and treatment to be provided to people with HIV through from specialized clinics.

It is worth mentioning that the diagnosis of HIV is considered opportune or on time when, at the time of detection, the person has an immune system almost as strong as someone who does not have the virus.

The value of time

The analysis, published in the medical journal PLoS ONE, reviewed how the time elapsed between the estimated time of HIV infection and the start of antiretroviral treatment affects the costs of care during the first five years of treatment. Added to this are other factors that also generate extra costs.

Data from 1,200 people who started treatment in 2013 were included; most were men. The research team classified the participants into three categories:

– Diagnosed on time: that is, with an acceptably strong immune system, measured with a number of CD4 cells greater than 350 cells/mm3 of blood.

– Late diagnosis: people with compromised immune systems, whose number of CD4 cells was between 200 and 350 cells/mm3.

– Diagnosed very late: those who showed a severely impaired immune system, with less than 200 cells/mm3.

When comparing people diagnosed late with those diagnosed early, the former were more likely to be older, of foreign origin, and to have acquired HIV through a heterosexual route.

As for the higher cost of care for people with late diagnosis, this was determined by expenses that were not directly related to HIV treatment, for example, treatment for other illnesses or hospital admissions.

It was observed that, during the first year of treatment, people with a very late diagnosis spent an average of 8.3 days hospitalized, well above the 0.38 days of hospitalization that those diagnosed on time had on average.

During the 5 years evaluated, people with a late diagnosis had a 56% cost overrun for the health system, and those with a very late diagnosis had a 246% cost overrun.

Obstacles to diagnosis

The authors of the study pointed out that people postpone HIV detection tests due to various factors, including the low perception of risk against the virus, which occurs especially in the heterosexual and cisgender population. Added to this is the scant information about HIV or the stigma attached to the infection, which causes people to avoid the test.

Faced with this panorama, it is important to disseminate accurate, scientific and stigma-free information to try to change the perception of HIV among those who do not feel at risk. In addition, the researchers add, the screening test should be approached and promoted among these groups, which would not only have benefits for the health of people with HIV, but would also bring significant savings.

Remember that at AHF Latin America and the Caribbean we work every day to bring HIV services closer to all people. If you want to take a free HIV test, locate our offices in your country and make your appointment now.