The Cost-effectiveness of Voluntary Counseling and Testina of Hospital Patients for HIV-Reply

In Reply.  —We thank the correspondents for their responses to our article, which concluded that inpatient HIV screening for the purposes of preventing health care worker infection was not cost-effective, but that screening to detect HIV infection may be cost-effective at seroprevalences exceeding 1% if a series of policy and ethical issues are addressed in a satisfactory manner.Drs Mundy and Quinn are mistaken in their assertion that we ignored the existence of universal precautions. We based our analyses on needlestick incidence data from three diverse hospitals; these data were gathered well after universal precautions were recommended by the CDC for the prevention of occupational HIV transmission. Thus, our models reflect the reality of adherence to universal precautions, not an idealized version of compliance with them.Our decision to model the denial of care to HIV-infected patients is based on the reality that unethical practices do sometimes occur. That is