Providing universal HIV testing for India's billion-plus population every five years can save millions of lives and prove to be a cost-effective approach to managing the epidemic, scientists, including Indian researchers, claim in a new study.
It would meet international standards of cost-effectiveness - and save millions of lives for decades - to test every person in the huge population of India every five years, according to the study.
The findings are based on a careful analysis of India's Human immunodeficiency virus (HIV) epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries.
A team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard, and in Chennai, India, integrated scores of factors specific to the country to find that testing for the whole country, with greater frequency for high-risk groups and areas, would pay off despite India's huge population of 1.21 billion.
"Testing even 800 million adults is a public health undertaking of a historic magnitude," said study co-lead author Dr Kartik Venkatesh, a postdoctoral fellow at Brown University and Women & Infants Hospital.
"But what we were able to show is that even if you increase the cost of HIV treatment and care pretty significantly and really decrease the number of individuals who would link to care, even under those dire circumstances, testing this frequently and this widely still was reasonable," Venkatesh said.
Co-author Dr Soumya Swaminathan, director of the National Institute for Research in Tuberculosis in Chennai, India, said the projections of the model will help the country in its battle with the epidemic, one of the world's largest.
"As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions," she said.
After extensive research to determine the best possible data for the country, researchers coded several other parameters into the model including what percentage of people would refuse the test (18 per cent), how many patients who test positive would get care (50 per cent), the prevalence of HIV in the population (0.29 per cent) etc.
As they ran the numbers to determine the costs and effects on patients of broader and more frequent testing, they compared the results to what would happen under the status quo, in which there is less-than-universal testing.
They found that testing the population every five years would be 'cost-effective' with a price of USD 1,900 per year of life saved (YLS) in general, and USD 1,300 per YLS among high-risk groups.
The study was published in the journal PLoS One.