False positive HIV diagnoses in resource limited settings: operational lessons learned for HIV programmes

Area of Science:

• Public Health
• Infectious Diseases
• Clinical Diagnostics

Background:

• Rapid HIV diagnostic tests can lead to false positives, resulting in misdiagnosis.
• Poor quality control, errors, and inadequate staff training contribute to HIV misclassification.
• Médecins Sans Frontières identified HIV-negative individuals in HIV programs in 2004, highlighting systemic issues.

Purpose of the Study:

• To audit HIV testing practices at three sites.
• To implement improved HIV testing algorithms and re-testing protocols.
• To assess the impact of re-testing on HIV program uptake.

Main Methods:

• An audit of HIV testing practices was conducted across three sites in the Democratic Republic of Congo, Burundi, and Ethiopia.
• HIV re-testing was offered to clients enrolled in HIV programs.
• Improved testing algorithms, including a confirmation test, were implemented alongside enhanced training, supervision, and quality control.

Main Results:

• A total of 44 false-positive cases were identified in the DRC, two in Burundi, and seven in Ethiopia.
• Some individuals with false-positive results had experienced social and medical consequences, including abandonment and initiation of antiretroviral therapy.
• Monthly testing volumes remained stable after the introduction of re-testing, indicating no negative impact on test uptake.

Conclusions:

• False HIV diagnoses have severe individual consequences and occur across various program settings.
• Implementing re-testing and improved diagnostic procedures is feasible and does not negatively affect patient engagement.
• Ensuring accurate HIV diagnosis is critical for individual well-being and efficient resource management in HIV programs.