{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:06:04Z","timestamp":1789517164978,"version":"build-2803163510"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PHE-318068"],"award-info":[{"award-number":["PHE-318068"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>GetCheckedOnline is an internet-based screening service aiming to increase HIV testing among gay, bisexual and other men who have sex with men (GBMSM). We assessed the cost-effectiveness of GetCheckedOnline in its first implementation phase at different uptake scenarios compared to clinic-based screening services alone in Metro Vancouver, Canada.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>From a healthcare payer\u2019s perspective, our cost-utility analysis used an established dynamic GBMSM HIV compartmental model estimating the probability of acquiring HIV, progressing through diagnosis, disease stages and treatment over a 30-year time horizon. The base case scenario assumed 4.7% uptake of GetCheckedOnline in 2016 (remainder using clinic-based services), with 74% of high-risk and 44% of low-risk infrequent testers becoming regular testers in five years. Scenario analyses tested increased GetCheckedOnline uptake to 10% and 15%.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The cost per test for GetCheckedOnline was $29.40 compared to clinic-based services $56.92. Compared with clinic-based screening services, the projected increase in testing frequency with 4.7% uptake of GetCheckedOnline increased the costs by $329,600 (95% Credible Interval: -$498,200, $571,000) and gained 4.53 (95%CrI: 0, 9.20) quality-adjusted life years (QALYs) in a 30-year time horizon. The probability of GetCheckedOnline being cost-effective was 34% at the threshold of $50,000 per QALY, and increased to 73% at the threshold of $100,000 per QALY. The results were consistent in the other uptake scenarios. The probability of GetCheckedOnline being cost-effective became 80% at the threshold of $50,000 per QALY if assuming 5-year time horizon.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>GetCheckedOnline is almost half the cost of clinic-based services on a per-test basis. However, increased access to testing should be balanced with risk profiles of patients to ensure the implementation can be a cost-effective strategy for increasing HIV screening among GBMSM in Metro Vancouver. Additional analyses are needed to understand the impact of internet-based screening including screening for other STIs and in other populations.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0294628","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T19:18:49Z","timestamp":1701112729000},"page":"e0294628","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cost-effectiveness of internet-based HIV screening among gay, bisexual and other men who have sex with men (GBMSM) in Metro Vancouver, Canada"],"prefix":"10.1371","volume":"18","author":[{"given":"Jose A.","family":"De Anda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4785-8998","authenticated-orcid":true,"given":"Michael A.","family":"Irvine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis","family":"Salway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon","family":"Haag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5978-6843","authenticated-orcid":true,"given":"Mark","family":"Gilbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"pone.0294628.ref001","author":"BC Centre for Disease Control.","year":"2019","journal-title":"HIV in British Columbia: Annual Surveillance Report 2017."},{"issue":"7","key":"pone.0294628.ref002","doi-asserted-by":"crossref","first-page":"e303","DOI":"10.1016\/S2352-3018(17)30045-0","article-title":"Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996\u20132013: a modelling study","volume":"4","author":"B Nosyk","year":"2017","journal-title":"Lancet HIV"},{"key":"pone.0294628.ref003","author":"World Health Organization","year":"2015","journal-title":"Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV."},{"key":"pone.0294628.ref004","author":"Public Health Agency of Canada.","year":"2014","journal-title":"Human Immunodeficiency Virus\u2014HIV Screening and Testing Guide."},{"issue":"11","key":"pone.0294628.ref005","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1097\/QAD.0b013e32832b7dca","article-title":"Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis","volume":"23","author":"S Attia","year":"2009","journal-title":"AIDS"},{"issue":"6","key":"pone.0294628.ref006","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"MS Cohen","year":"2011","journal-title":"N Engl J Med"},{"issue":"16","key":"pone.0294628.ref007","first-page":"2649","article-title":"Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver","volume":"27","author":"M Gilbert","year":"2013","journal-title":"British Columbia. 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