HIV Testing After a First Positive Rapid Diagnostic Test: A Role for Nucleic Acid Testing?

Area of Science:

• Public Health
• Infectious Disease Modeling
• Diagnostic Accuracy Studies

Background:

• Accurate and cost-effective human immunodeficiency virus (HIV) testing is crucial for public health interventions.
• Current HIV testing algorithms involve multiple steps, impacting cost and turnaround time.
• Optimizing testing strategies is essential to improve patient outcomes and reduce transmission.

Purpose of the Study:

• To develop and present an open-access, Excel-based model for simulating adult HIV testing algorithms.
• To investigate the trade-offs between diagnostic accuracy and costs for various HIV testing strategies.
• To explore the potential benefits of alternative testing algorithms, including point-of-care nucleic acid testing.

Main Methods:

• Development of an adaptable, Excel-based simulation model.
• Inclusion of currently recommended and alternative adult HIV testing algorithms.
• Comparative analysis of accuracy metrics and associated costs for each algorithm.

Main Results:

• The model simulates various HIV testing pathways, allowing for detailed cost-effectiveness analysis.
• Preliminary findings suggest that simpler algorithms, such as those using point-of-care nucleic acid testing, may present a favorable balance of cost and improved outcomes.
• Despite potentially higher initial costs, these advanced testing methods warrant further investigation.

Conclusions:

• The developed model serves as a valuable tool for preliminary investigations into HIV testing algorithm efficiency.
• Point-of-care nucleic acid testing algorithms show promise for improving HIV testing outcomes and should be prioritized for further research and field validation.
• Optimizing HIV testing strategies through innovative approaches like point-of-care nucleic acid testing is essential for advancing HIV prevention and care efforts.