{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:05:07Z","timestamp":1784005507887,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Objective<\/jats:title>\n To evaluate the epidemiological yield, cost-effectiveness, and mechanisms of diagnostic cascade attrition of active, expanded community-based HIV screening in a low-prevalence region, and to contextualize the regional management burden.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A prospective, non-randomized, quasi-experimental study was conducted (August\u2013December 2025) across six demographically matched sub-districts. Three implemented active community screening (intervention); three maintained routine facility-based testing (control). A deduplicated dual-track database mapped the diagnostic cascade, supplemented by a 7-month longitudinal cohort to assess regional disease burden. Micro-costing determined fixed and variable costs from a health-system perspective. The Number Needed to Screen (NNS), Cost Per New Diagnosis (CPND), and Incremental Cost-Effectiveness Ratio (ICER) were calculated, supported by Propensity Score Matching (PSM), permutation tests, and deterministic sensitivity analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 17,305 unique participants (intervention: 14,434; control: 2,871), the intervention expanded coverage in the 35\u201349 age cohort (35.0% vs. 25.5%,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). However, only one true new HIV diagnosis occurred in the intervention arm (yield: 0.0069%), showing no statistical difference from the control (0%, Fisher\u2019s exact test\n p<\/jats:italic>\n \u202f=\u202f1.000), a finding robustly confirmed by PSM and permutation tests. The overall NNS was 14,434, remaining undefined (&gt;1,250 and &gt;5,055) for the highly prioritized 18\u201349 age cohorts. Longitudinal cohort data revealed a stark demographic mismatch: 76.0% of true local incident cases were aged \u226750\u202fyears, and the regional management burden was increasingly driven by migrant populations rather than local transmission. Notably, 80.0% (8\/10) of reactive initial screens in the intervention group were previously diagnosed individuals, predominantly older males (87.5% male; 75.0% aged 50\u201364). While temporal correlation was not statistically significant (Spearman\u2019s\n \u03c1<\/jats:italic>\n \u202f=\u202f0.564,\n p<\/jats:italic>\n \u202f=\u202f0.322), the absolute metrics highlight substantial known-positive interference. Consequently, the intervention yielded an ICER of 504,886 CNY per additional diagnosis, remaining above the willingness-to-pay threshold even under extreme sensitivity scenarios.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In epidemiologically saturated settings, non-targeted community screening yields profound diminishing marginal returns. Material incentives inadvertently capture previously diagnosed older males who undergo repeated testing, resulting in substantial resource redundancy rather than identifying occult infections. To optimize cost-effectiveness, public health strategies must implement digital pre-screening interception mechanisms and strategically reallocate funds toward key-population friendly services and peer-driven interventions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1882126","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:22:12Z","timestamp":1784002932000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological yield and cost-effectiveness of non-targeted community HIV screening in a low-prevalence district: a prospective quasi-experimental study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yu","family":"Luo","sequence":"first","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Liu","sequence":"additional","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyue","family":"Fan","sequence":"additional","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglan","family":"Tan","sequence":"additional","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Yang","sequence":"additional","affiliation":[{"name":"Beibei Center for Disease Control and Prevention","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref1","volume-title":"Global HIV and AIDS Statistics \u2014 Fact Sheet |","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1186\/s12879-025-11812-7","article-title":"Disease burden of HIV and its behavioral risks among adults aged 20\u201354 years in China and the western pacific region from 1990 to 2021: an analysis based on the global burden of disease study 2021","volume":"25","author":"Liu","year":"2025","journal-title":"BMC Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e5575","DOI":"10.1371\/journal.pone.0005575","article-title":"Early antiretroviral therapy reduces AIDS progression\/death in individuals with acute opportunistic infections: a multicenter randomized strategy 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PLHIV in Lesotho","volume":"14","author":"Jubilee","year":"2019","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e25520","DOI":"10.1002\/jia2.25520","article-title":"Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia","volume":"23","author":"Mwango","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e0286458","DOI":"10.1371\/journal.pone.0286458","article-title":"HIV community index testing reaches proportionally more males than facility-based testing and is cost-effective: a study from Gaza province, Mozambique","volume":"18","author":"Songane","year":"2023","journal-title":"PLoS One"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1093\/heapol\/czae013","article-title":"The economic costs and cost-effectiveness of HIV self-testing among truck drivers in 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