Determination of HIV status in African adults with discordant HIV rapid tests
OUTPUT TYPE: Journal Article
PUBLICATION YEAR: 2015
TITLE AUTHOR(S): J.M.Fogel, E.Piwowar-Manning, K.Donohue, V.Cummings, M.A.Marzinke, W.Clarke, A.Breaud, A.Fiamma, D.Donnell, M.Kulich, J.K.K.Mbwambo, L.Richter, G.Gray, M.Sweat, T.J.Coates, S.H.Eshleman
KEYWORDS: ADULTS, HIV TESTING AND COUNSELLING (HTC), HIV/AIDS, HIV/AIDS STATUS
DEPARTMENT: Public Health, Societies and Belonging (HSC)
Print: HSRC Library: shelf number 8951
HANDLE: 20.500.11910/1674
URI: http://hdl.handle.net/20.500.11910/1674
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at researchoutputs@hsrc.ac.za.
Abstract
In resource-limited settings, HIV infection is often diagnosed using 2 rapid tests. If the results are discordant, a third tiebreaker test is often used to determine HIV status. This study characterized samples with discordant rapid tests and compared different testing strategies for determining HIV status in these cases. Samples were previously collected from 173 African adults in a population-based survey who had discordant rapid test results. Samples were classified as HIV positive or HIV negative using a rigorous testing algorithm that included two fourth generation tests, a discriminatory test, and 2 HIV RNA tests. Tie-breaker tests were evaluated, including rapid tests (1 performed in-country), a third-generation enzyme immunoassay, and two fourth-generation tests. Selected samples were further characterized using additional assays. Twenty-nine samples (16.8%) were classified as HIV positive and 24 of those samples (82.8%) had undetectable HIV RNA. Antiretroviral drugs were detected in 1 sample. Sensitivity was 8.3%-43% for the rapid tests; 24.1% for the third-generation enzyme immunoassay; 95.8% and 96.6% for the fourth-generation tests. Specificity was lower for the fourth-generation tests than the other tests. Accuracy ranged from 79.5% to 91.3%. In this population-based survey, most HIV-infected adults with discordant rapid tests were virally suppressed without antiretroviral drugs. Use of individual assays as tie-breaker tests was not a reliable method for determining HIV status in these individuals. More extensive testing algorithms that use a fourth-generation screening test with a discriminatory test and HIV RNA test are preferable for determining HIV status in these cases.-
Related Research Outputs:
- Using participatory mapping to inform a community-randomized trial of HIV counseling and testing
- Sexual behaviour, HIV status, and HIV risk among older South Africans
- Intervention package for KPIS
- Abstract: Determinants of the use of voluntary counselling and testing services among the sexually active adult population of South Africa
- Universal HIV testing of infants at immunization clinics: an acceptable and feasible approach for early infant diagnosis in high HIV prevalence settings
- HIV testing and self-reported HIV status in South African men who have sex with men: results from a community-based survey
- Test and tell: correlates and consequences of testing and disclosure of HIV status in South Africa (HPTN 043 Project Accept)
- Determinants of knowledge of HIV status in South Africa: results from a population-based HIV survey
- HIV symptoms and health-related quality of life prior to initiation of HAART in a sample of HIV-positive South Africans
- Innovative mobilization strategies for attracting at risk youth and young adults to participate in community-based voluntary counselling and testing in rural Kwa-Zulu Natal, South Africa (Project Accept - HPTN 043)
- The development of harmonized minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region: assessment report on HTC policy reviews
- Regional minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region
- Factors determining prenatal HIV testing for prevention of Mother to Child Transmission of HIV in Mpumalanga, South Africa
- Lay counsellor-based risk reduction intervention with HIV negative diagnosed patients at HIV counselling and testing sites in a rural South African setting
- Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review
- Approaches to HIV counselling and testing: strengths and weaknesses, and challenges for the way forward
- Routine HIV testing (RHT) and its implications for the socio-economic right of access to health care in South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Mauritius
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Zambia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Namibia