Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review

Fonner, Virginia A.; Sands, Anita; Figueroa, Carmen; Baggaley, Rachel; Quinn, Caitlin; Jamil, Muhammad S; Johnson, Cheryl

doi:10.1136/bmjgh-2019-001939

Cited by 10 publications

(12 citation statements)

References 13 publications

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“…Data from the field testing sites and NRL were analyzed using SAS 9.4 (SAS Institute, Cary, NC, USA) and Microsoft Excel (Microsoft Corporations, Redmond, USA). PLOS GLOBAL PUBLIC HEALTH 98.9% (28,242) were reactive on Test 2, while 1.1% (308) were non-reactive on Test 2 (Unigold). Of the non-reactive results with Test 2, the results show that 75% (231) were non-reactive and 25% (77) were reactive using the tie-breaker (Test 3 -Stat-Pak).…”

Section: Discussionmentioning

confidence: 97%

“…The participation of testing sites in continuous quality improvement, quality assurance, and adherence to the nationally validated HIV testing algorithm is crucial in reducing HIV misdiagnosis, both the initial diagnosis and the re-testing for verification [27]. Evidence shows that country adherence to WHO recommendations for HTS, re-testing for verification, and appropriate use of the national testing algorithm is vital to achieving accurate HIV diagnosis [28]. A previous study shows that re-testing for verification prior to ART initiation is instrumental to the reduction of HIV misdiagnosis and aids the quality assurance program for HIV testing services [29].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Nigeria national HIV rapid testing algorithm

Iriemenam

Mpamugo²,

Ikpeazu³

et al. 2022

PLOS Glob Public Health

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Human Immunodeficiency Virus (HIV) diagnosis remains the gateway to HIV care and treatment. However, due to changes in HIV prevalence and testing coverage across different geopolitical zones, it is crucial to evaluate the national HIV testing algorithm as false positivity due to low prevalence could be detrimental to both the client and the service delivery. Therefore, we evaluated the performance of the national HIV rapid testing algorithm using specimens collected from multiple HIV testing services (HTS) sites and compared the results from different HIV prevalence levels across the six geopolitical zones of Nigeria. The evaluation employed a dual approach, retrospective, and prospective. The retrospective evaluation focused on a desktop review of program data (n = 492,880) collated from patients attending routine HTS from six geopolitical zones of Nigeria between January 2017 and December 2019. The prospective component utilized samples (n = 2,895) collected from the field at the HTS and tested using the current national serial HIV rapid testing algorithm. These samples were transported to the National Reference Laboratory (NRL), Abuja, and were re-tested using the national HIV rapid testing algorithm and HIV-1/2 supplementary assays (Geenius to confirm positives and resolve discordance and multiplex assay). The retrospective component of the study revealed that the overall proportion of HIV positives, based on the selected areas, was 5.7% (28,319/492,880) within the study period, and the discordant rate between tests 1 and 2 was 1.1%. The prospective component of the study indicated no significant differences between the test performed at the field using the national HIV rapid testing algorithm and the re-testing performed at the NRL. The comparison between the test performed at the field using the national HIV rapid testing algorithm and Geenius HIV-1/2 supplementary assay showed an agreement rate of 95.2%, while that of the NRL was 99.3%. In addition, the comparison of the field results with HIV multiplex assay indicated a sensitivity of 96.6%, the specificity of 98.2%, PPV of 97.0%, and Kappa Statistic of 0.95, and that of the NRL with HIV multiplex assay was 99.2%, 99.4%, 99.0%, and 0.99, respectively. Results show that the Nigeria national serial HIV rapid testing algorithm performed very well across the target settings. However, the algorithm’s performance in the field was lower than the performance outcomes under a controlled environment in the NRL. There is a need to target testers in the field for routine continuous quality improvement implementation, including refresher trainings as necessary.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Evaluation of the Nigeria national HIV rapid testing algorithm

Iriemenam

Mpamugo²,

Ikpeazu³

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

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“…A post-hoc review of participants’ travel trajectories failed to reveal extended lengths of stay in other countries following departure, suggesting that HIV acquisition not only occurred prior to arrival in Canada but likely in participants’ birth countries. If this is the case, our study highlights that routine HIV testing may be sub-optimal in developing countries [ 19 , 20 ] despite global efforts to diagnose 90% of those infected with HIV [ 21 ]. Furthermore, while our results suggest remote transmission, domestic HIV transmission cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Phylogenetic Clustering among Asylum Seekers with New HIV-1 Diagnoses in Montreal, QC, Canada

Park

Brenner

Ibanescu

et al. 2021

Viruses

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Migrants are at an increased risk of HIV acquisition. We aimed to use phylogenetics to characterize transmission clusters among newly-diagnosed asylum seekers and to understand the role of networks in local HIV transmission. Retrospective chart reviews of asylum seekers linked to HIV care between 1 June 2017 and 31 December 2018 at the McGill University Health Centre and the Jewish General Hospital in Montreal were performed. HIV-1 partial pol sequences were analyzed among study participants and individuals in the provincial genotyping database. Trees were reconstructed using MEGA10 neighbor-joining analysis. Clustering of linked viral sequences was based on a strong bootstrap support (>97%) and a short genetic distance (<0.01). Overall, 10,645 provincial sequences and 105 asylum seekers were included. A total of 13/105 participant sequences (12%; n = 7 males) formed part of eight clusters. Four clusters (two to three people) included only study participants (n = 9) and four clusters (two to three people) included four study participants clustered with six individuals from the provincial genotyping database. Six (75%) clusters were HIV subtype B. We identified the presence of HIV-1 phylogenetic clusters among asylum seekers and at a population-level. Our findings highlight the complementary role of cohort data and population-level genotypic surveillance to better characterize transmission clusters in Quebec.

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“…We carried out a search of national policy documents related to HTS through searching WHO repositories, governmental and non-governmental websites and search engines and contacting WHO country contacts and regional experts through April 2018 and updated our database through August 2020 ( online supplemental file 1 ). 29 …”

Section: Methodsmentioning

confidence: 99%

Adolescents and age of consent to HIV testing: an updated review of national policies in sub-Saharan Africa

et al. 2021

Self Cite

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ObjectivesIn sub-Saharan Africa (SSA) where HIV burden is highest, access to testing, a key entry point for prevention and treatment, remains low for adolescents (aged 10–19). Access may be hampered by policies requiring parental consent for adolescents to receive HIV testing services (HTS). In 2013, the WHO recommended countries to review HTS age of consent policies. Here, we investigate country progress and policies on age of consent for HIV testing.DesignComprehensive policy review.Data sourcesPolicies addressing HTS were obtained through searching WHO repositories and governmental and non-governmental websites and consulting country and regional experts.Eligibility criteriaHTS policies published by SSA governments before 2019 that included age of consent.Data extraction and synthesisData were extracted on HTS age of consent including exceptions based on risk and maturity. Descriptive analyses of included policies were disaggregated by Eastern and Southern Africa (ESA) and Western and Central Africa (WCA) subregions.ResultsThirty-nine policies were reviewed, 38 were eligible; 19/38 (50%) permitted HTS for adolescents ≤16 years old without parental consent. Of these, six allowed HTS at ≥12 years old, two at ≥13, two at ≥14, five at ≥15 and four at ≥16. In ESA, 71% (n=15/21) allowed those of ≤16 years old to access HTS, while only 24% (n=6/25) of WCA countries allowed the same. Maturity exceptions including marriage, sexual activity, pregnancy or key population were identified in 18 policies. In 2019, 63% (n=19/30) of policies with clear age-based criteria allowed adolescents of 12–16 years old to access HIV testing without parental consent, an increase from 37% (n=14/38) in 2013.ConclusionsWhile many countries in SSA have revised their HTS policies, many do not specify age of consent. Revision of SSA consent to HTS policies, particularly in WCA, remains a priority to achieve the 2025 goal of 95% of people with HIV knowing their status.

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Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review

Cited by 10 publications

References 13 publications

Evaluation of the Nigeria national HIV rapid testing algorithm

Evaluation of the Nigeria national HIV rapid testing algorithm

Phylogenetic Clustering among Asylum Seekers with New HIV-1 Diagnoses in Montreal, QC, Canada

Adolescents and age of consent to HIV testing: an updated review of national policies in sub-Saharan Africa

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