Oral fluid-based rapid HIV testing: issues, challenges and research directions

Pai, Nitika Pant

doi:10.1586/14737159.7.4.325

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…This is consistent with observations from a recent study in Singapore in which incorrect interpretation of results as invalid was the most common error in reading test results [33]. These findings underscore the observation that despite the general high accuracy of oral-based rapid tests, there is still the chance of a false negative, false positive, or non-reactive result [46].…”

Section: Discussionsupporting

confidence: 90%

“…As this was a feasibility study, all the women in our study were aware that HIV self-testing was a screening tool and that a follow-up test would be required to confirm results. In our study, confirmation was performed against an agreed reference standard, as recommended [46]. However, the role of confirmatory testing outside of research studies should be examined to inform policy and programs.…”

Section: Discussionmentioning

confidence: 99%

“…This strategy could reduce the human resource cost for screening services, while achieving task shifting. While this potential exists, we are also cognisant that the provision of oral-based self-testing has financial implications [46,52]. Although recent evidence suggests that it is a cost-effective approach [53], it costs US $4 per test for this study, indicating a need to ensure that HIV tests remain affordable.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

Sarkar

Mburu

Shivkumar

et al. 2016

Journal of the International AIDS Society

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IntroductionHIV self-testing can increase coverage of essential HIV services. This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India.MethodsA cross-sectional, mixed methods study was conducted among 202 consenting pregnant women in a rural Indian hospital between August 2014 and January 2015. Participants were provided with instructions on how to self-test using OraQuick® HIV antibody test, and subsequently asked to self-test under supervision of a community health worker. Test results were confirmed at a government-run integrated counselling and testing centre. A questionnaire was used to obtain information on patient demographics and the ease, acceptability and difficulties of self-testing. In-depth interviews were conducted with a sub-sample of 35 participants to understand their experiences.ResultsIn total, 202 participants performed the non-invasive, oral fluid-based, rapid test under supervision for HIV screening. Acceptance rate was 100%. Motivators for self-testing included: ease of testing (43.4%), quick results (27.3%) and non-invasive procedure (23.2%). Sensitivity and specificity were 100% for 201 tests, and one test was invalid. Concordance of test result interpretation between community health workers and participants was 98.5% with a Cohen's Kappa (k) value of k=0.566 with p<0.001 for inter-rater agreement. Although 92.6% participants reported that the instructions for the test were easy to understand, 18.7% required the assistance of a supervisor to self-test. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Overall, 96.5% of the participants recommended that the OraQuick® test kits should become publicly available.ConclusionsSelf-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Participants were supportive of making self-testing publicly available. Policy guidelines and implementation research are required to advance HIV self-testing for larger populations at scale.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

Sarkar

Mburu

Shivkumar

et al. 2016

Journal of the International AIDS Society

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“…The testing kits and testing method have further been found to be accurate, much safer and easier to use and therefore recommended for adoption and use in the developing countries due to its simplicity, versatility and, feasibility that enables easier implementation and use even in rural areas and private health institutions [22,23]. Also, incorporation of oral HIV tests could form part of a multi-pronged prevention strategy in transforming the trajectory of the HIV epidemic in China and possibly the world at large [24,25].…”

Section: Introductionmentioning

confidence: 99%

Introducing rapid oral–fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges

et al. 2014

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BackgroundThis study was conducted to ascertain the feasibility of using rapid oral fluid testing as an alternative HIV testing method in China.MethodThis is a mixed-method study among men who have sex with men (MSM), female sex workers (FSW) and VCT clients, conducted in 4 cities in Shandong Province. A pre-tested questionnaire was administered to 1137 participants through face-to-face interview to assess demographic characteristics, HIV testing histories and willingness to accept rapid oral fluid testing. VCT clients were provided with the saliva test kits for a screening test and errors in operation were recorded. Testing results were compared between oral and blood testing. Short feedback questionnaire was administered to 200 FSW who had undergone oral testing.ResultsThe rate of willingness to take oral-fluid HIV testing among MSM, FSW and VCT clients was 72.8%, 72.1% and 67.4% respectively. Common errors recorded during test kit operation by the 229 VCT clients included: unpreparedness, wrong swab sampling, wrong dilution, wrong testing and inability to read test results. Advantages of oral testing listed by participants included: less intrusive, painlessness, easy self- testing and privacy. Disadvantages included perceived unreliable results (55.5%) and not nationally recognised (9%). Comparison of saliva and the blood testing results recorded a consistency rate of 0.970 (χ2 = 153.348, P < 0.001), implying an excellent consistency.ConclusionIntroduction of oral rapid fluid testing as an alternative HIV testing method in China is highly feasible but with some challenges including low recognition and operation errors.

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“…Despite its benefits and potential to increase HIV testing, there are several concerns related to this approach (Bateganya, Abdulwadud, & Kiene, 2010; Pai & Klein, 2008; Paltiel & Walensky, 2012). Although the kit can be purchased at any major pharmacy for about $50, the acceptability of this testing approach in highly vulnerable communities has not been explored (Pai, 2007). In addition to cost, testing without pre- and post-test counseling and lack of referral to relevant HIV care is a potential major limitation of HBHRT (Pai & Klein, 2008; Paltiel & Walensky, 2012).…”

mentioning

confidence: 99%

Strategies to Improve HIV Testing in African Americans

Kenya¹,

Okoro

Wallace

et al. 2015

Journal of the Association of Nurses in AIDS Care

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Only 17% of Miami-Dade County residents are African American, yet this population accounts for 59% of the county’s HIV-related mortality. The Centers for Disease Control and Prevention recommend annual testing for persons at increased risk for HIV, but 40% of African Americans have never been tested. OraQuick®, the first FDA-approved home-based HIV rapid test (HBHRT), has the potential to increase testing rates; however, there are concerns about HBHRT in vulnerable populations. We conducted focus groups in an underserved Miami neighborhood to obtain community input regarding HBHRT as a potential mechanism to increase HIV testing in African Americans. We queried HIV knowledge, attitudes toward research, and preferred intervention methods. Several HIV misconceptions were identified and participants expressed support for HIV research and introducing HBHRT into the community by culturally appropriate individuals trained to provide support. We concluded that community health workers paired with HBHRT were a promising strategy to increase HIV testing in this population.

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Oral fluid-based rapid HIV testing: issues, challenges and research directions

Cited by 19 publications

References 17 publications

Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

Introducing rapid oral–fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges

Strategies to Improve HIV Testing in African Americans

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