Details:

Alternative Title:
J Int AIDS Soc
Personal Author:
Kravitz Del Solar, Amy S ; Parekh, Bharat ; Douglas, Meaghan O'Keefe ; Edgil, Dianna ; Kuritsky, Joel ; ... More +
Kravitz Del Solar, Amy S ; Parekh, Bharat ; Douglas, Meaghan O'Keefe ; Edgil, Dianna ; Kuritsky, Joel ; Nkengasong, John Less -
Description:
As part of the global response to the HIV/AIDS epidemic, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is committed to the provision of high-quality services and ensuring testing accuracy. Two recently published papers focusing on HIV testing and misdiagnosis in sub-Saharan Africa by Kosack et al. report on evaluations of HIV rapid diagnostic tests (RDTs) and found lower than expected specificity and sensitivity on some tests when used in certain geographic locations. The magnitude of PEPFAR's global HIV response has been possible due to the extensive use of RDTs, which have made HIV diagnosis accessible all over the world. We take the opportunity to address concerns raised about the potential implications that these findings could have on real-world HIV testing accuracy. PEPFAR supported countries adhere to the normative guidance by World Health Organization (WHO) supporting algorithms which require sequential positive tests for diagnostic accuracy. An analysis of Médecins Sans Frontières (MSF) RDT site-specific data applied to PEPFAR in-country protocols demonstrate a variation in the diagnostic accuracy of the testing algorithms, but with a very small population-level effect. The data demonstrate, with the use of these algorithms, that the RDT outcomes found in the study by Kosack et al. would be largely mitigated and would not be expected to have a significant impact on diagnostic accuracy and overall programming in most countries. Avoiding any misdiagnosis is a priority for PEPFAR, and it remains vital to gain a deeper understanding of the causes and the extent of diagnostic errors and any misclassification. Extensive quality control mechanisms and continued research are essential. With a focus on epidemic control and ensuring diagnostic accuracy, PEPFAR recommends that all countries use WHO pre-qualified RDTs within the recommended strategies and algorithms for HIV testing. We also support validation of HIV testing algorithms using in-country specimens to determine optimal performance, and the reverification testing of all people diagnosed with HIV prior to starting treatment as an essential quality assurance measure.
Subjects:
[+]
Debate
Source:
J Int AIDS Soc. 21(8).
Pubmed ID:
30168275
Pubmed Central ID:
PMC6117497
Document Type:
Journal Article
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:73956ae208efababe5124d5be912b5bc3ceddc9153640090638a4a803333401a
Download URL:
https://stacks.cdc.gov/view/cdc/59655/cdc_59655_DS1.pdf
File Type:

Supporting Files

• JIA2-21-e25177.nxml

  xml

More +