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On-site HIV testing in resource-poor settings: is one rapid test enough?
D Wilkinson1, N Wilkinson, C Lombard
1Centre for Epidemiological Research in Southern Africa, Medical Research Council, Hlabisa Hospital, South Africa.
AIDS (London, England)
|March 1, 1997
Summary
Rapid, on-site HIV testing in rural hospitals is feasible, accurate, and cost-effective. This strategy significantly reduces test turnaround time and increases post-test counselling rates for patients.
Area of Science:
- Public Health
- Infectious Disease Management
- Health Services Research
Background:
- HIV testing is crucial for disease management and prevention.
- Traditional testing methods in rural settings can have long turnaround times.
- Resource-limited areas face challenges in implementing effective HIV testing strategies.
Purpose of the Study:
- To evaluate the feasibility, accuracy, and cost-effectiveness of rapid, on-site HIV testing.
- To assess the impact of rapid testing on test turnaround time.
- To determine the effect on the proportion of patients receiving post-test counselling.
Main Methods:
- Prospective comparison of on-site rapid HIV testing versus central enzyme-linked immunosorbent assay (ELISA).
- Economic evaluation of the rapid testing strategy.
- Study conducted at a rural South African district hospital with 454 adult inpatients.
Main Results:
- Rapid HIV testing demonstrated high concordance (99.3-100%) and accuracy (100% sensitivity, 99.6% specificity) compared to ELISA.
- Mean interval for post-test counselling decreased from 21 days to 4.6 days (P < 0.00001).
- Proportion of patients post-test counselled increased from 17% to 96% (P < 0.00001), with halved costs.
Conclusions:
- Rapid, on-site HIV testing is a feasible, accurate, and cost-effective strategy in high-prevalence, resource-poor settings.
- The strategy significantly improves patient outcomes by increasing post-test counselling.
- A single rapid test may be sufficient for accurate HIV diagnosis in these settings.