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Rapid Testing Algorithm Performance in a Low-Prevalence Environment
Eugene G Martin1, Julia Cornett, Debbie Y Mohammed2
1From the Department of Pathology and Laboratory Medicine, Rutgers University - Robert Wood Johnson Medical School, Somerset.
Sexually Transmitted Diseases
|January 25, 2020
Summary
A statewide HIV rapid test algorithm effectively identified true positives in a low-prevalence area. Discordant results were rare, but some early infections had low viral loads, highlighting the algorithm's utility.
Area of Science:
- Infectious Diseases
- Public Health
- Diagnostic Medicine
Background:
- Examined the 3-year performance of a statewide HIV rapid test algorithm (RTA) in a setting with 0.71% prevalence.
- Evaluated an RTA involving an initial HIV-1/2 Ag/Ab Combo test (RT#1) and Ab verification with a second rapid test (RT#2).
Purpose of the Study:
- To assess the effectiveness of a statewide HIV rapid test algorithm in a low-prevalence population.
- To evaluate the algorithm's ability to facilitate linkage to care and identify early infections.
Main Methods:
- Implemented an RTA with immediate referral for antigen-only-positive screens and RT#2 confirmation for antibody-positive screens.
- Collected specimens for discordant RTA results and tested using CDC/APHL algorithm, supplemented by quantitative viral load testing.
Main Results:
- Out of 310,785 tests, 2400 preliminary positives were identified, with 91.8% confirmed by RT#2.
- Identified 14 true positives from discordant results (7.1%), with 5 having viral loads <1000 copies/mL.
- Reported 3 false-positive RTAs among 2191 presumptive positives.
Conclusions:
- The HIV rapid test algorithm demonstrated effectiveness in identifying true HIV positives and aiding linkage to care.
- Discordant results were infrequent, but fingerstick antigen detection identified one early infection.
- Subsequent positive cases from discordant results often had low viral loads (<1000 copies/mL).
