Scaling Up HIV Rapid Testing in Developing Countries

Abstract

In the last few years, the use of HIV rapid testing has expanded worldwide in response to the call for universal access to prevention, care, and treatment by UNAIDS and the World Health Organization. HIV rapid testing is performed by people with varied skills in laboratory and nonlaboratory settings. Accurate HIV diagnostic testing is the first step to identifying infected persons for follow-up referral and care. However, there are several challenges related to test kit quality, test selection, testing algorithms, training, quality assurance (QA), quality of new lots, and postmarket performance. We highlight various issues that impact the quality of HIV rapid testing and provide solutions to monitor and improve test accuracy, especially in resource-limited settings. These include the use of validated kits, training with emphasis on QA, use of a standardized log book, dried-tube specimen-based proficiency testing, new kit lot verification, and postmarket surveillance. Systematic implementation of these tools should greatly enhance the quality of HIV rapid testing.

Poor Performance of the Determine HIV-1/2 Ag/Ab Combo Fourth-Generation Rapid Test for Detection of Acute Infections in a National Household Survey in Swaziland

“…The high concordance of the two-serial-RT algorithm to accurately identify HIV infections in a household-based survey is a reflection of the intense training of the field staff on performing the rapid tests and the QA processes. This study provides documented evidence that these QA measures can be successfully implemented in the field to ensure quality testing and accurate diagnosis (38).…”

Multicenter Feasibility Study To Assess External Quality Assessment Panels for Xpert MTB/RIF Assay in South Africa

“…The implementation of a new assay in settings with users who are often not experienced with laboratory testing creates many challenges in the quality system (10), even though the test in question is designed for users with minimal expertise. The quality system, as described by the Clinical and Laboratory Standards Institute (CLSI), is intended to ensure the quality of the overall testing process (from specimen collection to result reporting for patient management), to detect and reduce errors, to improve consistency within and between laboratories, to contain costs, and to ensure customer satisfaction.…”

The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review

“…HIV counselling and testing (HCT), a gateway for HIV treatment, has been brought to scale with tens of millions of annual tests. [1][2][3][4] Individual and couple HCT (cHCT) are essential for linking HIV-infected persons to HIV treatment, which reduces morbidity, mortality and horizontal and vertical transmissibility. 5 6 Similarly, individual and cHCT can now serve as referral points for HIV-uninfected men to access medical male circumcision, and, in the near future, may serve as an entry point for antiretroviral pre-exposure prophylaxis.…”