Understanding low sensitivity of community-based HIV rapid testing : experiences from the HPTN 071 (PopART) trial in Zambia and South Africa

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dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorPhiri, Comforten_ZA
dc.contributor.authorPiwowar-Manning, Estelleen_ZA
dc.contributor.authorKosloff, Barryen_ZA
dc.contributor.authorMandla, Nomthaen_ZA
dc.contributor.authorYoung, Aliciaen_ZA
dc.contributor.authorJames, Aneleten_ZA
dc.contributor.authorSchaap, A. b.en_ZA
dc.contributor.authorScheepers, Michelleen_ZA
dc.contributor.authorDonnell, Deborahen_ZA
dc.contributor.authorGriffith, Samen_ZA
dc.contributor.authorEl-Sadr, Wafaaen_ZA
dc.contributor.authorShanaube, Kwameen_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.contributor.authorHayes, Richarden_ZA
dc.contributor.authorFidler, Sarahen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.date.accessioned2018-10-23T08:01:50Z
dc.date.available2018-10-23T08:01:50Z
dc.date.issued2017-08-27
dc.descriptionCITATION: Bock, P., et al. 2017. Understanding low sensitivity of community-based HIV rapid testing : experiences from the HPTN 071 (PopART) trial in Zambia and South Africa. Journal of the International AIDS Society, 20(S6):21780, doi:10.7448/IAS.20.7.21780.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com
dc.description.abstractIntroduction: Population-wide HIV testing services (HTS) must be delivered in order to achieve universal antiretroviral treatment (ART) coverage. To accurately deliver HTS at such scale, non-facility-based HIV point-of-care testing (HIV-POCT) is necessary but requires rigorous quality assurance (QA). This study assessed the performance of community-wide HTS in Zambia and South Africa (SA) as part of the HPTN 071 (PopART) study and explores the impact of quality improvement interventions on HTS performance. Methods: Between 2014 and 2016, HIV-POCT was undertaken within households both as part of the randomly selected HPTN 071 research cohort (Population Cohort [PC]) and as part of the intervention provided by community HIV-care providers. HIVPOCT followed national algorithms in both countries. Consenting PC participants provided a venous blood sample in addition to being offered HIV-POCT. We compared results obtained in the PC using a laboratory-based gold standard (GS) testing algorithm and HIV-POCT. Comprehensive QA mechanisms were put in place to support the community-wide testing. Participants who were identified as having a false negative or false positive HIV rapid test were revisited and offered retesting. Results: We initially observed poor sensitivity (45–54%, 95% confidence interval [CI] 31–69) of HIV-POCT in the PC in SA compared to sensitivity in Zambia for the same time period of 95.8% (95% CI 93–98). In both countries, specificity of HIVPOCT was >98%. With enhanced QA interventions and adoption of the same HIV-POCT algorithm, sensitivity in SA improved to a similar level as in Zambia. Conclusions: This is one of the first reports of HIV-POCT performance during wide-scale delivery of HTS compared to a GS laboratory algorithm. HIV-POCT in a real-world setting had a lower sensitivity than anticipated. Appropriate choice of HIVPOCT algorithms, intensive training and supervision, and robust QA mechanisms are necessary to optimize HIV-POCT test performance when testing is delivered at a community level. HIV-POCT in clients who did not disclose that they were on ART may have contributed to false negative HIV-POCT results and should be the topic of future research.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/full/10.7448/IAS.20.7.21780
dc.description.versionPublisher's version
dc.format.extent9 pagesen_ZA
dc.identifier.citationBock, P., et al. 2017. Understanding low sensitivity of community-based HIV rapid testing : experiences from the HPTN 071 (PopART) trial in Zambia and South Africa. Journal of the International AIDS Society, 20(S6):21780, doi:10.7448/IAS.20.7.21780
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:10.7448/IAS.20.7.21780
dc.identifier.urihttp://hdl.handle.net/10019.1/104592
dc.language.isoen_ZAen_ZA
dc.publisherWiley Open Accessen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectHIV infections -- Preventionen_ZA
dc.subjectAntiretroviral drugsen_ZA
dc.subjectHIV (virus) -- Testing -- Counselingen_ZA
dc.titleUnderstanding low sensitivity of community-based HIV rapid testing : experiences from the HPTN 071 (PopART) trial in Zambia and South Africaen_ZA
dc.typeArticleen_ZA
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