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M94A2675.TXT
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1994-10-25
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Document 2675
DOCN M94A2675
TI Cost effectiveness of different confirmatory HIV testing schedules in
Colombia.
DT 9412
AU Boshell J; Gonzalez M; Rey E; Rojas MC; Marrugo S; Instituto Nacional de
Salud, Bogota, Colombia.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):250 (abstract no. PB0429). Unique
Identifier : AIDSLINE ICA10/94369900
AB OBJECTIVE: To compare the cost-effectiveness of two different testing
strategies for HIV infection using data from a follow-up study. METHODS:
The NIH of Colombia (Instituto Nacional Salud-INS) in Bogota is the
HIV-Nat. Reference Lab. and performs WB testing on all sera with an
Initial Reactive Screening Assay (IRSA) submitted by Blood Banks and
public and Private labs in the country. A total of 6648 WB tests were
performed between 1990-93 and 1644 had in Indeterminate (IND) report
following the allgorithm IRSA-WB-REPORT. We traced 134 IND individual
for whom additional sera were available after the first INS report.
RESULTS: Forty seven of 134 samples (35%) became negative in the WB
after a time interval of (3-143) weeks, 22 became positive (16%) after
(2-130) weeks and 65 continued to give an IND WB serology after (3-165)
weeks of follow-up. We were able to assay an average of 2,3 (2-4)
2,1(2-3) and 2,4 (2-6) samples in each category. A second ELISA (Abbott)
was performed at the INS on the 65 samples in the IND category after
follow-up: 51 were negative (79%) an 14 (21%) continued positive.
Reactivity for HILV-I antibodies was tested by ELISA and WB, in 32 (49%)
of these 65 IND sera: none were WB positive. PCR has not yet been
performed on any sample. DISCUSSION AND CONCLUSIONS: Many international
agencies (WHO, PAHO, CDC) recommend that only duplicate repeat reactive
initial screening results be confirmed by a supplemental test. Our
experience confirms this recommendation, as we found that 79% of the
samples giving an IND WB result were not repeatedly reactive by ELISA.
If this result holds true for the 1644 IND WBs performed in our 3 year
study period, it would suggest that 1299 of these assays were
unnecesary. If we take in to account a cost of US$60 per assay we could
have saved 60 x 1299 x 2.4 = US$187.056.00 by performing a repeated
ELISA before carrying out the WB.
DE AIDS Serodiagnosis/*ECONOMICS Blotting, Western/ECONOMICS Colombia
Comparative Study Cost-Benefit Analysis *Developing Countries
Enzyme-Linked Immunosorbent Assay/ECONOMICS Follow-Up Studies Human
HIV Antigens/*BLOOD HIV Seropositivity/*DIAGNOSIS/ECONOMICS/IMMUNOLOGY
Predictive Value of Tests MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).