High Accuracy of Home-Based Community Rapid HIV Testing in Rural Malawi

Molesworth, Anna; Ndhlovu, Richard; Banda, Emmanuel; Saul, Jacqueline; Ngwira, Bagrey; Glynn, Judith R.; Crampin, Amelia C.; French, Neil

doi:10.1097/qai.0b013e3181f98628

Cited by 57 publications

(50 citation statements)

References 15 publications

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“…Yield of HIV positive individuals (HIV positivity) was reported in 29 home studies 14,15,18,27,29–32,34,36,38,41–45,63,65,66,68,70–73,88,89 , one home with self-testing 11 , 12 mobile 10,13,68,72,92–95,97,98,103,107,114 , five campaign 46,47,76,77,120 , three workplace 79,80,121 , four key population 12,115,116,122 , four index partner 48–50,88 , 27 facility VCT 54–56,64,81,84,88,91–93,95,98,102,104–107,114,118–120,123–127 , and 17 facility PITC 56,57,59,60,81,83–88,99,110–113,126 studies. Community-based strategies for the general population had lower HIV positivity (6–11%) than facility HTC (18–20%), whereas targeted community HTC for key populations and sexual partners of index patients had the highest HIV yield (Fig.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

451

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

451

532

View full text Add to dashboard Cite

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“…Several studies of RDT performance in both community- and health facility-based HIV testing have reported higher sensitivities than observed in our study. Molesworth et al found a sensitivity of 99% comparing third-generation RDT kits with third-generation EIA during HIV testing in the context of a household survey, using initially two RDTs in parallel with a tiebreaker, then two RDTs in series with a tiebreaker and finally retesting all positives and 10% of the negatives in the laboratory [22]. Jackson et al found a sensitivity of 98% in a community randomized controlled trial of home-based HCT conducted by lay counsellors again comparing third-generation RDT kits with a third-generation EIA [23].…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of HIV infection during a South African community‐based survey: implications for rapid HIV testing

Kufa

Kharsany

Cawood

et al. 2017

Journal of the International AIDS Society

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Introduction: We describe the overall accuracy and performance of a serial rapid HIV testing algorithm used in community-based HIV testing in the context of a population-based household survey conducted in two sub-districts of uMgungundlovu district, KwaZulu-Natal, South Africa, against reference fourth-generation HIV-1/2 antibody and p24 antigen combination immunoassays. We discuss implications of the findings on rapid HIV testing programmes. Methods: Cross-sectional design: Following enrolment into the survey, questionnaires were administered to eligible and consenting participants in order to obtain demographic and HIV-related data. Peripheral blood samples were collected for HIV-related testing. Participants were offered community-based HIV testing in the home by trained field workers using a serial algorithm with two rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using two fourth-generation immunoassays with all positives in the confirmatory test considered true positives. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and false-positive and false-negative rates were determined. Results: Of 10,236 individuals enrolled in the survey, 3740 were tested in the home (median age 24 years (interquartile range 19–31 years), 42.1% males and HIV positivity on RDT algorithm 8.0%). From those tested, 3729 (99.7%) had a definitive RDT result as well as a laboratory immunoassay result. The overall accuracy of the RDT when compared to the fourth-generation immunoassays was 98.8% (95% confidence interval (CI) 98.5–99.2). The sensitivity, specificity, positive predictive value and negative predictive value were 91.1% (95% CI 87.5–93.7), 99.9% (95% CI 99.8–100), 99.3% (95% CI 97.4–99.8) and 99.1% (95% CI 98.8–99.4) respectively. The false-positive and false-negative rates were 0.06% (95% CI 0.01–0.24) and 8.9% (95% CI 6.3–12.53). Compared to true positives, false negatives were more likely to be recently infected on limited antigen avidity assay and to report antiretroviral therapy (ART) use. Conclusions: The overall accuracy of the RDT algorithm was high. However, there were few false positives, and the sensitivity was lower than expected with high false negatives, despite implementation of quality assurance measures. False negatives were associated with recent (early) infection and ART exposure. The RDT algorithm was able to correctly identify the majority of HIV infections in community-based HIV testing. Messaging on the potential for false positives and false negatives should be included in these programmes.

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“…20,21 We searched Pubmed and EMBASE for community-based HTC studies published between January 1 st , 2000, and June 12th, 2014, with the terms HIV and Africa South of the Sahara and (mass screening OR testing OR screen OR diagnosis OR counseling). We identified 1,004 abstracts for review, including two recent systematic reviews.…”

Section: Research In Contextmentioning

confidence: 99%

“…16 Community-based HTC strategies include community campaigns, 17 which achieve large numbers of testing in a short period, and home HTC, 18,19 through which HIV counseling and testing is provided by lay counselors in homes. 20,21 Systematic reviews found that community-based HTC, 16 including home HTC, 19 were acceptable and resulted in high uptake of testing. In addition, studies have demonstrated high linkage to care 16 and viral suppression over 6 months.…”

Section: Introductionmentioning

confidence: 99%

Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study

et al. 2014

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Objective Antiretroviral therapy (ART) significantly decreases HIV-associated morbidity, mortality, and HIV transmission through HIV viral load suppression. In high HIV prevalence settings, outreach strategies are needed to find asymptomatic HIV positive persons, link them to HIV care and ART, and achieve viral suppression. Methods We conducted a prospective intervention study in two rural communities in KwaZulu-Natal, South Africa, and Mbabara district, Uganda. The intervention included home HIV testing and counseling (HTC), point-of-care CD4 count testing for HIV positive persons, referral to care, and one month then quarterly lay counselor follow-up visits. The outcomes at 12 months were linkage to care, and ART initiation and viral suppression among HIV positive persons eligible for ART (CD4≤350 cells/μL). Findings 3,393 adults were tested for HIV (96% coverage), of whom 635 (19%) were HIV positive. At baseline, 36% of HIV positive persons were newly identified (64% were previously known to be HIV positive) and 40% were taking ART. By month 12, 619 (97%) of HIV positive persons visited an HIV clinic, and of 123 ART eligible participants, 94 (76%) initiated ART by 12 months. Of the 77 participants on ART by month 9, 59 (77%) achieved viral suppression by month 12. Among all HIV positive persons, the proportion with viral suppression (<1,000 copies/mL) increased from 50% to 65% (p=<0.001) at 12 months. Interpretation Community-based HTC in rural South Africa and Uganda achieved high testing coverage and linkage to care. Among those eligible for ART, a high proportion initiated ART and achieved viral suppression, indicating high adherence. Implementation of this HTC approach by existing community health workers in Africa should be evaluated to determine effectiveness and costs.

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High Accuracy of Home-Based Community Rapid HIV Testing in Rural Malawi

Abstract: Face-to-face rapid testing by health personnel with minimum training at the client's home performs well when used on a wide scale in the community setting.

Cited by 57 publications

References 15 publications

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Misdiagnosis of HIV infection during a South African community‐based survey: implications for rapid HIV testing

Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study

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