Purpose: In 2003, as part of the Advancing HIV Prevention initiative, CDC funded community-based organizations (CBOs) to provide voluntary HIV counseling and rapid testing (CRT) to populations at high risk for HIV in a variety of venues, including outreach settings using mobile vans. The objective of this study is to assess the costs and effects (e.g., number of newly diagnosed HIV infections) of CRT performed by a CBO in a community clinic and in outreach settings using a mobile van.

Methods: The Kansas City (MO) Free Clinic (KCFC) offered CRT in the clinic and outreach settings from May 2004 through March 2006. We retrospectively collected the costs of conducting CRT, including staff time, training, recruitment, travel, equipment, the purchase and operation of a mobile van, supplies, test kits, administration and overhead. Costs are expressed in US 2006 dollars. Outcomes included the number of HIV tests performed, the number of newly-diagnosed HIV cases identified in each setting, and the cost per newly diagnosed case.

Results: The CRT program tested an average of 855 and 703 clients per year in the community clinic and outreach settings, respectively, and the average number of newly diagnosed HIV-positive cases were 18 and 3, respectively. The estimated annual total program cost was $68,609 for the clinic and $79,669 for outreach settings. The average total program cost associated with testing an HIV-negative person in the clinic and outreach settings was $78 and $113, respectively, with an incremental cost of $85 in both settings for HIV-positive persons. The total program cost per newly diagnosed HIV infection was $3,868 in the clinic and $25,450 in outreach.

Conclusion: The cost per newly diagnosed HIV infection was much lower in community clinic settings than in outreach settings where clients were reached by a mobile van. The variation was due to differences in HIV seropositivity among those tested, and in average testing costs. The latter variation was largely due to costs associated with the mobile van. Cost-effectiveness results from this CBO strongly suggest funding HIV testing in clinic rather than in outreach settings. However, because HIV prevalence and average testing costs could vary by CBO, whether to use mobile vans for rapid HIV testing in other U.S. locations should be evaluated on a case-by-case basis.