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Published on: October 31, 2010
Pooled testing: A tool to increase efficiency of infant HIV diagnosis and virological monitoring
Wolfgang Preiser1,2, Gert U van Zyl1,2
1Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Pooled testing offers an efficient strategy for early infant diagnosis (EID) and viral load monitoring in HIV programs. While effective for ART monitoring, its application for EID requires further investigation, though modeling suggests promise.
Area of Science:
- Public Health
- Infectious Disease Diagnostics
- Virology
Background:
- Pooled testing is a long-established method for diagnosing rare conditions, such as infections in blood donors.
- HIV prevention of mother-to-child transmission and antiretroviral therapy (ART) programs are expanding in Africa, increasing demand for early infant diagnosis (EID) and viral load testing.
- Declining rates of infant HIV infections and ART failures necessitate innovative, efficient testing strategies like pooled testing.
Purpose of the Study:
- To review the necessity and challenges of universal EID and viral load coverage.
- To introduce pooled testing and discuss key considerations for its implementation.
- To provide an overview of studies on pooled testing for EID and virological monitoring.
Main Methods:
- Literature review and analysis of existing studies on pooled testing.
- Exploration of pooled testing's applicability to early infant diagnosis (EID) and viral load monitoring.
- Discussion of practical and economic factors influencing pooling strategies.
Main Results:
- Pooled testing has demonstrated accuracy and efficiency for ART monitoring.
- Pooled testing has not yet been applied to EID, but modeling indicates potential benefits.
- The review contextualizes pooled testing within current and future HIV/ART programs in Africa.
Conclusions:
- Key considerations for pooled testing include pre-selection of samples, use of dried blood/plasma spots, and selection of feasible, economical pooling strategies.
- Further research and novel approaches are needed to enhance the attractiveness and utility of pooled testing.
- Optimizing pooled testing can support the evolving landscape of HIV/ART programs and diagnostics.
Background:
Pooled testing, or pooling, has been used for decades to efficiently diagnose relatively rare conditions, such as infection in blood donors. Programmes for the prevention of mother-to-child transmission of HIV and for antiretroviral therapy (ART) are being rolled out in much of Africa and are largely successful. This increases the need for early infant diagnosis (EID) of HIV using qualitative nucleic acid testing and for virological monitoring of patients on ART using viral load testing. While numbers of patients needing testing are increasing, infant HIV infections and ART failures are becoming rarer, opening an opportunity for pooled testing approaches.
Aim:
This review highlights the need for universal EID and viral load coverage as well as the challenges faced. We introduce the concept of pooled testing and highlight some important considerations before giving an overview of studies exploring pooled testing for EID and virological monitoring.
Results:
For ART monitoring, pooling has been shown to be accurate and efficient; for EID it has not been tried although modelling shows it to be promising. The final part attempts to place pooling into the context of current mother-to-child transmission of HIV and ART programmes and their expected trajectories over the next years.
Conclusion:
Several points warrant consideration: pre-selection to exclude samples with an elevated pre-test probability of positivity from pooled testing, the use of dried blood or plasma spots, and choosing a pooling strategy that is both practically feasible and economical. Finally, novel ideas are suggested to make pooling even more attractive.
