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Effect of Relapse to High-Risk Behavior on the Costs and Benefits of a Program to Screen Women for Human Immunodeficiency Virus

Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, and Division of General Internal Medicine and Department of Health Research and Policy, Stanford University, Stanford, California 94305
Department of Industrial Engineering and Engineering Management, Stanford University, Stanford, California 94305
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755

We carried out an analysis to determine the effect of women's relapse to high-risk sexual and needle-sharing behavior on the costs and benefits of a voluntary program to screen women of childbearing age for HIV, the virus that causes AIDS. The analysis is based on a dynamic model of the HIV epidemic, combined with an economic model that assesses costs and benefits of such a program. We find that, for women with high prescreening levels of high-risk behavior, even small and short-lived reductions in sexual or needle-sharing high-risk behaviors in response to counseling and testing can produce benefits that outweigh costs. The effect of relapse to high-risk behaviors on screening program costs and benefits can be substantial, and this effect is most notable in screening programs that reach women of all risk groups. Behavioral interventions that produce sustained reductions in risk behavior could be cost saving even if the interventions were expensive.

Key Words: health care; epidemiology