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Optimizing HIV testing algorithms for pre-exposure prophylaxis (PrEP) is crucial. A streamlined approach using two rapid tests (RTs) offers similar accuracy to traditional methods, reducing delays and costs for HIV diagnosis.

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Area of Science:

  • Clinical Medicine
  • Infectious Diseases
  • Public Health

Background:

  • HIV pre-exposure prophylaxis (PrEP) requires accurate and timely HIV testing to ensure safety and efficacy.
  • Current HIV testing algorithms often involve multiple steps, including rapid tests (RTs) and Western blot (WB) confirmation, leading to delays and increased costs.
  • Optimizing these algorithms is essential to minimize drug resistance risk, reduce time off PrEP, and expedite treatment initiation.

Purpose of the Study:

  • To evaluate the accuracy and efficiency of a streamlined HIV testing algorithm for PrEP eligibility.
  • To compare the diagnostic performance of a two-rapid-test approach versus traditional RT plus WB confirmation.
  • To assess the utility of nucleic acid testing for resolving discrepant RT results.

Main Methods:

  • The study analyzed HIV testing data from the iPrEx trial, which involved daily oral emtricitabine-tenofovir disoproxil fumarate for HIV-seronegative men and transgender women.
  • HIV infection was assessed using two RTs with WB confirmation and HIV-1 plasma viral load testing.
  • A simulation compared the accuracy of a streamlined algorithm (two RTs) against the standard algorithm.

Main Results:

  • Over 51,000 HIV status evaluations were conducted among nearly 2,500 volunteers.
  • A small percentage of screening tests yielded reactive results (0.28% concordant positive, 0.04% discordant).
  • A streamlined approach using two RTs demonstrated nearly equivalent accuracy to the standard RT plus WB method, with nucleic acid testing recommended for discrepant results.

Conclusions:

  • A streamlined HIV testing algorithm using two rapid tests is a viable and accurate alternative to traditional methods for PrEP eligibility assessment.
  • This optimized approach can significantly reduce diagnostic delays and costs associated with HIV testing.
  • Nucleic acid testing should be employed to confirm discrepant rapid test results, enhancing diagnostic sensitivity.