Educational and Economic Outcomes of an Intervention to Improve Early Testing and Treatment of HIV

Background: Education is needed to address professional practice gaps in testing, linkage to care, and treatment of human immunodeficiency virus (HIV) in the primary care setting. Further, little is known about the economic impact of continuing medical education in this area. Methods: We executed one online and two live continuing education activities designed to enhance competence in testing and treating HIV. Competence was measured using pre- and post-activity case vignettes. Costs averted when participants implemented learning into their clinical practices were estimated using the outcomes impact analysis (OIA) model. We modeled: 1) decreased transmission of HIV resulting from awareness of infection and 2) earlier initiation of antiretroviral therapy (ART). The perspective was that of the healthcare payer and the time span was one year. Results: Participants from the live (n = 64) and online (n = 230) activities demonstrated educationally and statistically significant improvement in all 3 competencies (P ≤  .01 for all). Evaluations demonstrated a strong commitment to change and the intention to incorporate learning into practice. For the first OIA model, the estimated costs averted were be $10,731,517 when testing related awareness led to decreased transmission. For the second OIA model, earlier treatment comparing ART initiation at 351-500 CD4 cells/μL versus 201-350 CD4 cells/μL, the estimated costs averted were $11,685,686. When we compared initiating ART at 351-500 CD4 cells/μL versus < 200 CD4 cells/μL, the costs averted were estimated to be $39,521,676. Conclusions: An educational intervention improved competence in testing, linkage to care, and treatment of HIV. Estimates of the economic impact suggest that implementation of learning from the activity is associated with substantial cost savings.