Brief Report: Self-Reported HIV-Positive Status but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment Survey Participants-11 Sub-Saharan African Countries, 2015-2018.

Journal

Journal of acquired immune deficiency syndromes (1999)

ISSN: 1944-7884

Titre abrégé: J Acquir Immune Defic Syndr

Pays: United States

ID NLM: 100892005

Informations de publication

Date de publication:
01 Apr 2024

Historique:

received: 06 06 2023

accepted: 05 10 2023

medline: 27 2 2024

pubmed: 27 2 2024

entrez: 27 2 2024

Statut: ppublish

Résumé

HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018. Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate. Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection. A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.

Sections du résumé

BACKGROUND BACKGROUND

METHOD METHODS

Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate.

RESULTS RESULTS

Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection.

CONCLUSIONS CONCLUSIONS

A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.

Identifiants

DOI: 10.1097/QAI.0000000000003363 PMID: 38412045

pubmed: 38412045

doi: 10.1097/QAI.0000000000003363

pii: 00126334-202404010-00002

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

313-317

Subventions

Organisme : U.S. Presidentâ€s Emergency Plan for AIDS Relief

ID : #U2GGH001271and #U2GGH001226.

Informations de copyright

Déclaration de conflit d'intérêts

The authors have no funding or conflicts of interest to disclose.

Références

WHO. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Recommendations for a Public Health Approach. World Health Organization; 2016. https://www.who.int/publications/i/item/9789241549684

Lasry A, Kalou MB, Young PR, et al. Cost implications of HIV retesting for verification in Africa. PLoS One. 2019;14:e0218936.

Kufa T, Lane T, Manyuchi A, et al. The accuracy of HIV rapid testing in integrated bio-behavioral surveys of men who have sex with men across 5 provinces in South Africa. Medicine (Baltimore). 2017;96:e7391.

Kufa T, Kharsany AB, Cawood C, et al. Misdiagnosis of HIV infection during a South African community-based survey: implications for rapid HIV testing. J Int AIDS Soc. 2017;20(suppl 6):21753.

Shanks L, Klarkowski D, O'Brien DP. False positive HIV diagnoses in resource limited settings: operational lessons learned for HIV programmes. PLoS One. 2013;8:e59906.

Kosack CS, Shanks L, Beelaert G, et al. HIV misdiagnosis in sub-Saharan Africa: performance of diagnostic algorithms at six testing sites. J Int AIDS Soc. 2017;20:21419.

Jahun I, Ehoche A, Bamidele M, et al. Evaluation of accuracy and performance of self-reported HIV and antiretroviral therapy status in the Nigeria AIDS Indicator and Impact Survey (2018). PLoS One. 2022;17:e0273748.

Xia Y, Milwid RM, Godin A, et al. Accuracy of self-reported HIV-testing history and awareness of HIV-positive status in four sub-Saharan African countries. AIDS (London, England). 2021;35:503–510.

Sachathep K, Radin E, Hladik W, et al. Population-based HIV impact assessments survey methods, response, and quality in Zimbabwe, Malawi, and Zambia. J Acquir Immune Defic Syndr. 2021;87(suppl 1):S6–S16.

Patel HK, Duong YT, Birhanu S, et al. A comprehensive approach to assuring quality of laboratory testing in HIV surveys: lessons learned from the population-based HIV impact assessment project. J Acquir Immune Defic Syndr. 2021;87(suppl 1):S17–S27.

Johnston LG, Sabin ML, Prybylski D, et al. The importance of assessing self-reported HIV status in bio-behavioural surveys. Bull World Health Organ. 2016;94:605–612.

Harbertson J, Hale BR, Tran BR, et al. Self-reported HIV-positive status but subsequent HIV-negative test result using rapid diagnostic testing algorithms among seven sub-Saharan African military populations. PLoS One. 2017;12:e0180796.

Johnson CC, Fonner V, Sands A, et al. To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status. J Int AIDS Soc. 2017;20(suppl 6):21755.

Johnson CC, Dalal S, Baggaley R, et al. A public health approach to addressing and preventing misdiagnosis in the scale-up of HIV rapid testing programmes. J Int AIDS Soc. 2017;20(suppl 6):22190.

Gray RH, Makumbi F, Serwadda D, et al. Limitations of rapid HIV-1 tests during screening for trials in Uganda: diagnostic test accuracy study. BMJ. 2007;335:188.

World Health Organization. Consolidated Guidelines on HIV Testing Services. World Health Organization; 2019. https://www.who.int/publications/i/item/978-92-4-155058-1

World Health Organization. WHO Encourages Countries to Adapt HIV Testing Strategies in Response to Changing Epidemic. World Health Organization; 2019. https://www.who.int/publications/i/item/WHO-CDS-HIV-19.34

Fogel JM, Piwowar-Manning E, Debevec B, et al. Brief report: impact of early antiretroviral therapy on the performance of HIV rapid tests and HIV incidence assays. J Acquir Immune Defic Syndr. 2017;75:426–430.