From the 2024 HVPA National Conference
Xiyu Zhao BS (Johns Hopkins University School of Medicine), Valerie Tu BS (Johns Hopkins University Department of Biomedical Engineering), Wallace Wennerberg BS, Ariel Leong BS, Mark Schuweiler BS, Padmini Ranasinghe MD, MPH
Background:
The Southeastern United States is disproportionately affected by the HIV epidemic, with significant disparities in the incidence of HIV infections among African American communities and men who have sex with men (MSM) [1-4]. These disparities are intensified by socioeconomic factors, limited healthcare access, and pervasive HIV-related stigma. Medical literature has demonstrated vending machine-based health interventions for HIV-testing as a promising strategy to increase accessibility to disease testing have shown success in various settings [5-9]. However, no literature has detailed out the costs and savings of such an initiative.
Objective:
To project the cost savings and health outcomes of a vending-machine-based initiative designed to provide confidential HIV testing and subsequent linkage to care services in the Southeast.
Methods:
A comprehensive financial model was constructed to calculate the potential healthcare savings and public health benefits of the initiative. This model utilizes a conservative growth estimate informed by previous studies on intervention uptake and incorporates user growth rates, anticipated HIV infection rates based on regional epidemiological data, and the average cost of HIV treatment as per Medicaid expenditure reports. Implementation costs are detailed with operating expenses covering the deployment of the vending machines, procurement of FDA-approved HIV self-test kits, and the establishment of a robust telehealth infrastructure. Personnel costs reflect the required investment in software engineering, community health workers, and project management to ensure successful execution and sustainability.
Results:
The financial projections suggest that the initiative could prevent an estimated 300 HIV infections in its first year, with a consequential saving of $4.1 million in healthcare costs. Additionally, the model forecasts an incremental rise in both prevented infections and savings, reaching up to 754 averted infections and over $10.5 million in savings by 2030. Initial implementation costs are estimated at $1.21 million, accounting for full operational setup and staff training. A break-even analysis indicates that the investment would be offset by the direct cost savings within the first few months of operation.
Conclusions:
A vending-machine-based initiative to provide confidential HIV testing and subsequent linkage to care services in the Southeast could prove to be financially viable in the Southeast.
Clinical Implications:
If implemented, the integration of technology and health services via a vending machine model can bridge current care delivery gaps and provides a scalable solution to enhance patient care quality, improve safety, and optimize the patient care experience.