Pooling of sera for human immunodeficiency virus (HIV) testing: an economical method for use in developing countries.

Emmanuel, Jean; Bassett, Mary T.; Smith, Harry; Jacobs, Ja

doi:10.1136/jcp.41.5.582

Cited by 104 publications

(91 citation statements)

References 5 publications

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“…10,11 A reported history of infant mortality was associated with HIV infection in both groups of women. This could be used in risk assessment of women seeking reproductive health services and could be used as an entry point for HIV counselling and testing that may lead to the promotion of prevention of mother to child transmission (PMTCT).…”

Section: Discussionmentioning

confidence: 99%

HIV and Sexually Transmitted Infections among Women Presenting at Urban Primary Health Care Clinics in Two Cities of sub-Saharan Africa

Mbizvo

Msuya

Hussain

et al. 2005

African Journal of Reproductive Health

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In a cross-sectional study, 786 consenting women from two cities in Africa, Harare and Moshi, attending primary health care clinics were interviewed, examined and tested for HIV and other sexually transmitted infections (STIs). The aim of the study was to assess and compare differences in the characteristics that may affect the prevalence of HIV/STIs among women in the two cities. Multivariate analysis was used to generate odds ratio. STIs and behaviour characteristics among this low risk group of women could not fully explain the higher HIV prevalence in Zimbabwe, 29.3% compared to 11.5% in Tanzania

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Section: Discussionmentioning

confidence: 99%

HIV and Sexually Transmitted Infections among Women Presenting at Urban Primary Health Care Clinics in Two Cities of sub-Saharan Africa

Mbizvo

Msuya

Hussain

et al. 2005

African Journal of Reproductive Health

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“…A potential disadvantage of pooled testing, however, is a decrease in test sensitivity through dilution of positive specimens beyond an assay limit of detection (10). The cost savings of pooled testing are determined by the prevalence of disease in the tested population, the number of samples per pool, and the degree of clustering of positive individuals in the tested population (6,11).…”

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confidence: 99%

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confidence: 99%

“…One approach that can reduce costs is to pool (put together) specimens from several patients and test them using a single test (6,7). If a pool tests positive, then each specimen is tested individually to detect the positive sample(s), whereas if the pooled specimens test negative, all individuals are considered infection free (6,7). A pooling strategy appears to be cost-effective and accurate when NAATs are used to screen blood for HIV (8) and blood-borne hepatitis viruses (9), detect Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens (7), and identify influenza virus in nasopharyngeal swab samples (4).…”

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confidence: 99%

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Testing Pooled Sputum with Xpert MTB/RIF for Diagnosis of Pulmonary Tuberculosis To Increase Affordability in Low-Income Countries

Abdurrahman¹,

Mbanaso

Lawson

et al. 2015

J Clin Microbiol

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Tuberculosis (TB) is a global public health problem, with the highest burden occurring in low-income countries. In these countries, the use of more sensitive diagnostics, such as Xpert MTB/RIF (Xpert), is still limited by costs. A cost-saving strategy to diagnose other diseases is to pool samples from various individuals and test them with single tests. The samples in positive pool samples are then retested individually to identify the patients with the disease. We assessed a pooled testing strategy to optimize the affordability of Xpert for the diagnosis of TB. Adults with presumptive TB attending hospitals or identified by canvassing of households in Abuja, Nigeria, were asked to provide sputum for individual and pooled (4 per T uberculosis (TB) is a significant global public health problem (1). Despite the availability of curative treatment, TB sits behind only human immunodeficiency virus (HIV) as the major cause of mortality associated with infectious disease worldwide (1). In 2013 there were an estimated 9 million new cases and 1.5 million deaths from TB, most of which occurred in low-and middle-income countries (LMICs) (1). The highest rates of TB per capita and the highest proportion of cases with HIV coinfection occur in sub-Saharan Africa (1).In most low-income countries, direct sputum smear microscopy is the mainstay of TB diagnostics (2), as this test is inexpensive and highly specific, but it has a low to moderate sensitivity (2). The sensitivity of direct sputum smear microscopy is lower in patients with paucibacillary disease associated with HIV coinfection and in children, due to lower bacillary loads (3), and it cannot provide information on drug susceptibility (4). Conversely, sputum culture, in particular, automated liquid culture, is the most sensitive and specific diagnostic tool available for TB and facilitates drug susceptibility testing (2). However, culture requires a laboratory infrastructure, including biosafety equipment, not widely available in low-resource settings, and results typically take 2 to 6 weeks and, therefore, are rarely helpful for initial treatment decisions (2, 4).The Xpert MTB/RIF (Xpert) assay (Cepheid Inc., Sunnyvale, CA, USA) is a self-contained, fully automated, real-time PCR assay that facilitates rapid semiquantitative detection of Mycobacterium tuberculosis and rifampin (RIF) resistance with minimal laboratory requirements compared to those needed for culture and other manually operated nucleic acid amplification tests (NAATs) (4). Xpert is highly specific (99%) and substantially more sensitive than smear microscopy (4). The assay's turnaround time is less than 2 h, greatly shortening the time to TB diagnosis in locations where the machine is available, and it detects markers of RIF resistance (4). For low-income countries, the single-use cartridges cost $9.98 (FIND, 2013). However, despite this concessionary pricing, the cost involved to purchase and run the tests is still a limiting factor for widespread sustainable adoption of Xpert by TB control programs i...

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“…12,13 Pooled testing to estimate prevalence and to identify infected individuals has been proposed as a cost-efficient approach for diseases with low prevalence, 8,11,24 including HIV, Chlamydia trachomatis, and hepatitis B infections in humans. 2,6,7,9,10,16,[18][19][20]26 In veterinary diagnostic medicine, pooled testing has been used to identify Salmonella enteritidis in eggs, Trichinella spiralis in pigs, and hypodermosis and bovine leukemia virus infection in cattle. 5,17,22,23 Among diagnostic techniques available for detection of BVDV, polymerase chain reaction (PCR) is well suited to pooled-sample testing based on the ability to detect very low levels of virus.…”

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confidence: 99%

Pooled-Sample Testing as a Herd-Screening Tool for Detection of Bovine Viral Diarrhea Virus Persistently Infected Cattle

et al. 2000

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Abstract. The study was conducted to develop methodology for least-cost strategies for using polymerase chain reaction (PCR)/probe testing of pooled blood samples to identify animals in a herd persistently infected with bovine viral diarrhea virus (BVDV). Cost was estimated for 5 protocols using Monte Carlo simulations for herd prevalences of BVDV persistent infection (BVDV-PI) ranging from 0.5% to 3%, assuming a cost for a PCR/probe test of $20. The protocol associated with the least cost per cow involved an initial testing of pools followed by repooling and testing of positive pools. For a herd prevalence of 1%, the least cost per cow was $2.64 (95% prediction interval ϭ $1.72, $3.68), where pool sizes for the initial and repooled testing were 20 and 5 blood samples per pool, respectively. Optimization of the least cost for pooled-sample testing depended on how well a presumed prevalence of BVDV-PI approximated the true prevalence of BVDV infection in the herd. As prevalence increased beyond 3%, the least cost increased, thereby diminishing the competitive benefit of pooled testing. The protocols presented for sample pooling have general application to screening or surveillance using a sensitive diagnostic test to detect very low prevalence diseases or pathogens in flocks or herds.

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Pooling of sera for human immunodeficiency virus (HIV) testing: an economical method for use in developing countries.

Cited by 104 publications

References 5 publications

HIV and Sexually Transmitted Infections among Women Presenting at Urban Primary Health Care Clinics in Two Cities of sub-Saharan Africa

HIV and Sexually Transmitted Infections among Women Presenting at Urban Primary Health Care Clinics in Two Cities of sub-Saharan Africa

Testing Pooled Sputum with Xpert MTB/RIF for Diagnosis of Pulmonary Tuberculosis To Increase Affordability in Low-Income Countries

Pooled-Sample Testing as a Herd-Screening Tool for Detection of Bovine Viral Diarrhea Virus Persistently Infected Cattle

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