Diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending an urban public health facility in Kampala, Uganda

Abstract

BackgroundThe prevalence of HIV in Uganda is 7.3%, and yet nearly 40% of people living with HIV are unaware of their status. The current HIV testing policy which is strictly blood-based poses several challenges including: a need for high level laboratory skills, stringent waste disposal needs, and painful sample collection. It is envisaged that introduction of a rapid, painless HIV oral fluid test as a potential alternative is likely to increase the number of people testing. The aim of this study was to determine the diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending Kisenyi Health Centre IV in Kampala.Methods and findingsWe conducted a cross-sectional study among 440 adults recruited consecutively at Kisenyi Health Centre IV from January to March 2016. The diagnostic accuracy of the HIV oral test was assessed by comparing to the national HIV serial testing algorithm. We also assessed for acceptability among patients and health care workers (HCWs) by triangulating responses from a structured questionnaire, three focus group discussions and seven key informant interviews. Acceptability was defined as willingness to take the test at the time of the study and intention for future use of the test if it was availed.The prevalence of HIV infection among study participants was 14.8%. The HIV oral fluid test was highly accurate with sensitivity of 100% (95% CI; 94.5–100.0), specificity of 100% (95% CI; 99.0–100.0), positive predictive value (PPV) of 100% (95% CI; 94.5–100.0) and negative predictive value (NPV) of 100% (95% CI; 99.0–100.0). Acceptability of HIV oral testing was also high at 87.0% (95% CI; 83.6–89.9). Participants preferred HIV oral testing because it was: pain free (91%, n = 399) and did not require blood draw (82%, n = 360).ConclusionThe HIV oral fluid test has high diagnostic accuracy and acceptability. HIV oral testing is a suitable addition to the national HIV testing strategies with the potential of increasing access to HIV testing services in Uganda.

Uptake of oral-based HIV self-testing among Key Populations taking HIV pre-exposure prophylaxis in central Uganda

“…These were non-invasiveness of the test procedure, being painless, ease of use, lack of blood loss, and cost effectiveness. These findings did not differ much from an acceptability study conducted in the general population in Uganda (17), and from other studies conducted elsewhere (11,21). It is feared that blood-based methods can cause blood loss and injury to the body, causing cosmetic concerns for some KP groups such as sex workers.…”

“…Similarly, another study from Kenya by Mugo et al (16) on the uptake and acceptability of an oral HIVST among pharmacy clients showed a high level (84%) of uptake of the test. Another related study conducted in Uganda to determine the accuracy and acceptability of rapid HIV oral testing revealed a rate of acceptability of 87% among 440 clients attending an urban health facility in Kampala (17). As these studies were conducted from a similar setting, they are likely to offer some understanding on the acceptability of oral HIVST in the Ugandan context.…”

HIV screening in men and women in Senegal: coverage and associated factors analysis of the 2017 demographic and health survey

“…To address this gap, we advocate strengthening HIV testing campaigns in secondary schools as well as increasing school-based educational programs. The use of urinary or saliva rapid HIV tests can be promoted as they are associated with HIV testing (28,29). However, a study conducted in the USA has shown that the optimal age for HIV testing adolescents and young adults is 25, and screening at age 18 or younger is a less efficient strategy (11).…”

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia

“…Oral fluid collection has also already been shown to be acceptable to a group of children for HCV testing and in adults for HIV testing. Other minimally invasive tests such as dry blood spot finger prick have also been used to identify individuals with HBsAg . Although a simple oral sampling method that needs centralized processing may still be associated with losses to follow‐up, it may prove useful for epidemiological serosurveys.…”

“…Other minimally invasive tests such as dry blood spot finger prick have also been used to identify individuals with HBsAg. [26][27][28] Although a simple oral sampling method that needs centralized processing may still be associated with losses to follow-up, it may prove useful for epidemiological serosurveys. Oral fluid has variable sensitivity (78%-100%) and specificity (87%-100%) for the detection of HBsAg and depends on collection devices, population and cut-off values used in immunoassays.…”