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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The failure of routine rapid HIV testing: A case study of improving low sensitivity in the field
BMC Health Services Research, Volume 10, Article 73, Year 2010
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Description
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. © 2010 Wolpaw et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Wolpaw, Benjamin Jonathan
South Africa, Tygerberg
South African Medical Research Council
Mathews, Catherine
South Africa, Tygerberg
South African Medical Research Council
South Africa, Cape Town
School of Public Health
Chopra, Mickey
South Africa, Bellville
University of the Western Cape
Hardie, Diana Ruth
South Africa, Cape Town
University of Cape Town
de Azevedo, Virginia
South Africa, Cape Town
Cape Town City Council
Jennings, Karen Ann
South Africa, Cape Town
Cape Town City Council
Lurie, Mark N.
United States, Providence
Brown University
Statistics
Citations: 63
Authors: 7
Affiliations: 6
Identifiers
Doi:
10.1186/1472-6963-10-73
e-ISSN:
14726963
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Case Study
Study Approach
Qualitative
Study Locations
South Africa