HIV testing in 2006: issues and methods

Abstract

Infection with HIV and subsequent development of AIDS is a pandemic. The Joint United Nations Program on HIV/AIDS together with the WHO and many relevant funding bodies demand that those infected should be reliably identified so that people who need, or will need, therapy may be provided for over time. This means that there is a renewed interest in testing for HIV and in laboratories' performances and quality. Whatever the conditions under which testing is performed, and whatever the levels of training, the tests and their outcomes must exhibit equivalent, high standards of performance and reliable results. This is regardless of whether testing is conducted in the most sophisticated laboratories (either diagnostic or transfusion screening) to voluntary testing and counseling centers where those conducting testing may not be technically trained. This is not currently the case, especially in some places where HIV is most prevalent. To achieve uniformly high performance standards, quality assurance programs are imperative, but currently not sufficiently valued to be well supported with adequate funding or human resources. Accurate HIV testing is a cornerstone of blood safety, diagnosis of infection, patient management and surveillance.

Assessing Proficiency of Interpretation of Rapid Human Immunodeficiency Virus Assays in Nonlaboratory Settings: Ensuring Quality of Testing

“…The accurate interpretation of rapid HIV assays in weakly reactive samples by inexperienced operators, especially when experienced laboratory participants had difficulty, implies that inexperience impacts significantly on the accuracy of results with these samples. This emphasizes the importance of training, as has been suggested previously (7,(20)(21)(22)(23)32). Photographed rapid HIV assay results as cost-effective training tools therefore will have importance in both initial and ongoing training programs.…”

“…Consequently, it is important that the rapid HIV assays being used in nonlaboratory settings (e.g., voluntary counseling and testing centers within communities in developing countries) are equal in quality to that expected of laboratories. Inadequate quality assurance and minimal or inappropriate training present limitations to the usefulness and cost effectiveness of nonlaboratory-based rapid diagnostic testing programs (7,17,21).…”

“…The implementation of the essentials of quality management and monitoring outcomes through quality assurance programs will reduce variability and increase the accuracy of interpretation, therefore providing confidence in the testing process (6,7,10,17). Laboratory quality assurance monitors all aspects of the testing process (preanalytic, analytic, and postanalytic) and employs two major methods (5,7). Quality control (QC) is used to check that an analytical phase (test precision) is optimal (9,13,16).…”

The failure of routine rapid HIV testing: a case study of improving low sensitivity in the field

“…HIV testing also remains critical to prevention efforts as well as programs providing psychological support. The rapid HIV antibody test, performed on whole blood collected from a finger prick, is the diagnostic tool of choice due to low cost, relative ease of use, and speed in obtaining results [2]. Current WHO guidelines for the use of rapid HIV testing in resource constrained settings recommend the use of rapid-test kits with >99% sensitivity and there are a number of available options with this level of accuracy [1].…”

Clinical outcomes of routine opt‐out antenatal human immunodeficiency virus screening: a systematic review

“…The emergence of routine testing was also complemented by the use of rapid HIV test kit. The rapid HIV test kit is relatively easy to use, is at low cost and produces results quickly (Chang et al 2006) usually in <30 minutes, and women are able to receive a post-test counselling on the same day without a prolonged waiting period lasting up to one to two weeks as obtained with enzyme-linked immunosorbent antigen (ELIZA). This means that those who are living with the virus can begin to receive all the necessary support they need in one day.…”