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Centre for HIV and STIs, National Institute for Communicable Diseases School of Public Health, University of the Witwatersrand, Johannesburg, South Africa Center for AIDS Prevention Studies, University of California, San Francisco, CA Anova Health Institute, Johannesburg, South Africa Global Health Sciences, University of California, San Francisco, CA Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town School of Public Health & Family Medicine, University of Cape Town, Cape Town Centres for Disease Control and Prevention (CDC), Pretoria Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
Published: July 2017
AI Article Synopsis
Article Abstract
We describe the accuracy of serial rapid HIV testing among men who have sex with men (MSM) in South Africa and discuss the implications for HIV testing and prevention.This was a cross-sectional survey conducted at five stand-alone facilities from five provinces.Demographic, behavioral, and clinical data were collected. Dried blood spots were obtained for HIV-related testing. Participants were offered rapid HIV testing using 2 rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using a third-generation enzyme immunoassay (EIA) and a fourth-generation EIA as confirmatory. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive, and false-negative rates were determined.Between August 2015 and July 2016, 2503 participants were enrolled. Of these, 2343 were tested by RDT on site with a further 2137 (91.2%) having definitive results on both RDT and EIA. Sensitivity, specificity, positive predictive value, negative predictive value, false-positive rates, and false-negative rates were 92.6% [95% confidence interval (95% CI) 89.6-94.8], 99.4% (95% CI 98.9-99.7), 97.4% (95% CI 95.2-98.6), 98.3% (95% CI 97.6-98.8), 0.6% (95% CI 0.3-1.1), and 7.4% (95% CI 5.2-10.4), respectively. False negatives were similar to true positives with respect to virological profiles.Overall accuracy of the RDT algorithm was high, but sensitivity was lower than expected. Post-HIV test counseling should include discussions of possible false-negative results and the need for retesting among HIV negatives.
