The failure of routine rapid HIV testing: a case study of improving low sensitivity in the field

 

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dc.contributor.author Wolpaw, Benjamin en_ZA
dc.contributor.author Mathews, Catherine en_ZA
dc.contributor.author Chopra, Mickey en_ZA
dc.contributor.author Hardie, Diana en_ZA
dc.contributor.author de Azevedo, Virginia en_ZA
dc.contributor.author Jennings, Karen en_ZA
dc.contributor.author Lurie, Mark en_ZA
dc.date.accessioned 2015-10-28T07:09:15Z
dc.date.available 2015-10-28T07:09:15Z
dc.date.issued 2010 en_ZA
dc.identifier.citation Wolpaw, B. J., Mathews, C., Chopra, M., Hardie, D., de Azevedo, V., Jennings, K., & Lurie, M. N. (2010). The failure of routine rapid HIV testing: a case study of improving low sensitivity in the field. BMC health services research, 10(1), 73. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14482
dc.identifier.uri http://dx.doi.org/10.1186/1472-6963-10-73
dc.description.abstract BACKGROUND:The rapid HIV antibody test is the diagnostic tool of choice in low and middle-income countries. Previous evidence suggests that rapid HIV diagnostic tests may underperform in the field, failing to detect a substantial number of infections. A research study inadvertently discovered that a clinic rapid HIV testing process was failing to detect cases of established (high antibody titer) infection, exhibiting an estimated 68.7% sensitivity (95% CI [41.3%-89.0%]) over the course of the first three weeks of observation. The setting is a public service clinic that provides STI diagnosis and treatment in an impoverished, peri-urban community outside of Cape Town, South Africa. METHODS: The researchers and local health administrators collaborated to investigate the cause of the poor test performance and make necessary corrections. The clinic changed the brand of rapid test being used and later introduced quality improvement measures. Observations were made of the clinic staff as they administered rapid HIV tests to real patients. Estimated testing sensitivity was calculated as the number of rapid HIV test positive individuals detected by the clinic divided by this number plus the number of PCR positive, highly reactive 3rd generation ELISA patients identified among those who were rapid test negative at the clinic. RESULTS: In the period of five months after the clinic made the switch of rapid HIV tests, estimated sensitivity improved to 93.5% (95% CI [86.5%-97.6%]), during which time observations of counselors administering tests at the clinic found poor adherence to the recommended testing protocol. Quality improvement measures were implemented and estimated sensitivity rose to 95.1% (95% CI [83.5%-99.4%]) during the final two months of full observation. CONCLUSIONS: Poor testing procedure in the field can lead to exceedingly low levels of rapid HIV test sensitivity, making it imperative that stringent quality control measures are implemented where they do not already exist. Certain brands of rapid-testing kits may perform better than others when faced with sub-optimal use. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an open access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Health Services Research en_ZA
dc.source.uri http://www.biomedcentral.com/bmchealthservres/ en_ZA
dc.subject.other HIV Infections en_ZA
dc.subject.other Mass Screening en_ZA
dc.subject.other Quality Control en_ZA
dc.subject.other Reagent Kits, Diagnostic en_ZA
dc.title The failure of routine rapid HIV testing: a case study of improving low sensitivity in the field en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2010 Wolpaw et al; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Public Health and Family Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an open access article distributed under the terms of the Creative Commons Attribution License