SEARCHCROSS-SECTIONALinfectious disease, public health

cross-sectional·infectious disease, public health, epidemiology, clinical trial, research methods·PMC10021713

Evaluation of the Nigeria national HIV rapid testing algorithm

PLOS Global Public Health · 35 authors, 9 centres

AI SUMMARY

FIDELITY 100%

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

A cross-sectional evaluation using retrospective program data from 492,880 clients and prospective specimens from 2,895 clients found that Nigeria's national serial HIV rapid testing algorithm (Determine, Unigold, Stat-Pak) performed well overall but achieved lower sensitivity and PPV in the field than in the controlled laboratory environment.

Full summary

1,059 CHARS

This study evaluated Nigeria's national serial HIV rapid testing algorithm (Determine, Unigold, and Stat-Pak) in two phases. The retrospective phase reviewed routine HTS program data (n = 492,880) from six geopolitical zones (January 2017 to December 2019), finding an overall HIV positivity of 5.7% and a discordant rate of 1.1% between Tests 1 and 2. The prospective phase collected 2,895 samples from field HTS sites, retested them at the National Reference Laboratory using the same algorithm and supplementary assays (Geenius and multiplex). Field testing showed sensitivity of 96.6% and PPV of 97.0% compared with the multiplex assay, while NRL retesting achieved sensitivity of 99.2% and PPV of 99.0%, meeting WHO-recommended thresholds. All discordant rates were below the WHO-recommended 5% threshold. Limitations include the cross-sectional design, purposive site selection, and reliance on routine program data for the retrospective component. The findings support a need for continuous quality improvement and refresher training for field testers.

STUDY TYPE

cross-sectional

SPECIALTY

infectious disease

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10021713

Evaluation of the Nigeria national HIV rapid testing algorithm

PLOS Global Public Health

READ THE FULL PAPER

ABSTRACT

Human Immunodeficiency Virus (HIV) diagnosis remains the gateway to HIV care and treatment. However, due to changes in HIV prevalence and testing coverage across different geopolitical zones, it is crucial to evaluate the national HIV testing algorithm as false positivity due to low prevalence could be detrimental to both the client and the service delivery. Therefore, we evaluated the performance of the national HIV rapid testing algorithm using specimens collected from multiple HIV testing services (HTS) sites and compared the results from different HIV prevalence levels across the six geopolitical zones of Nigeria. The evaluation employed a dual approach, retrospective, and prospective. The retrospective evaluation focused on a desktop review of program data (n = 492,880) collated from patients attending routine HTS from six geopolitical zones of Nigeria between January 2017 and December 2019. The prospective component utilized samples (n = 2,895) collected from the field at the HTS and tested using the current national serial HIV rapid testing algorithm. These samples were transported to the National Reference Laboratory (NRL), Abuja, and were re-tested using the national HIV rapid testing algorithm and HIV-1/2 supplementary assays (Geenius to confirm positives and resolve discordance and multiplex assay). The retrospective component of the study revealed that the overall proportion of HIV positives, based on the selected areas, was 5.7% (28,319/492,880) within the study period, and the discordant rate between tests 1 and 2 was 1.1%. The prospective component of the study indicated no significant differences between the test performed at the field using the national HIV rapid testing algorithm and the re-testing performed at the NRL. The comparison between the test performed at the field using the national HIV rapid testing algorithm and Geenius HIV-1/2 supplementary assay showed an agreement rate of 95.2%, while that of the NRL was 99.3%. In addition, the comparison of the field results with HIV multiplex assay indicated a sensitivity of 96.6%, the specificity of 98.2%, PPV of 97.0%, and Kappa Statistic of 0.95, and that of the NRL with HIV multiplex assay was 99.2%, 99.4%, 99.0%, and 0.99, respectively. Results show that the Nigeria national serial HIV rapid testing algorithm performed very well across the target settings. However, the algorithm’s performance in the field was lower than the performance outcomes under a controlled environment in the NRL. There is a need to target testers in the field for routine continuous quality improvement implementation, including refresher trainings as necessary.

CITATION EXPORT

Nnaemeka C. Iriemenam, Augustine Mpamugo, Akudo Ikpeazu et al.. Evaluation of the Nigeria national HIV rapid testing algorithm. PLOS Global Public Health. (2022). https://doi.org/10.1371/journal.pgph.0001077

AUTHORS

35 · 9 CENTRES

Nnaemeka C. Iriemenam, Augustine Mpamugo, Akudo Ikpeazu, Olumide O. Okunoye, Edewede Onokevbagbe, Orji O. Bassey, Jelpe Tapdiyel, Matthias A. Alagi, Chidozie Meribe, Mukhtar L. Ahmed, Gabriel Ikwulono, Rose Aguolu, Gregory Ashefor, Charles Nzelu, Akipu Ehoche, Babatunde Ezra, Christine Obioha, Ibrahim Baffa Sule, Oluwasanmi Adedokun, Nwando Mba, Chikwe Ihekweazu, Manhattan Charurat, Brianna Lindsay, Kristen A. Stafford, Dalhatu Ibrahim, Mahesh Swaminathan, Ernest L. Yufenyuy, Bharat S. Parekh, Sylvia Adebajo, Alash’le Abimiku, McPaul I. Okoye, Hannah Hogan Leslie, Hannah Hogan Leslie, Hannah Hogan Leslie, Hannah Hogan Leslie

1 Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
2 Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation – an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
3 Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
4 National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
5 National Reference Laboratory, Nigeria Centers for Disease Control, Gaduwa, Federal Capital Territory, Nigeria
6 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
7 Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
8 International Laboratory Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
University of California San Francisco, UNITED STATES

EDITOR / REVIEWER

Hannah Hogan Leslie