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Efficacy and acceptability of rapid, point-of-care HIV testing in two clinical settings in Ghana
Global Health Sciences Literature Digest
Published October 19, 2009
Journal Article

Appiah LT, Havers F, Gibson J, Kay M, Sarfo F, Chadwick D. Efficacy and acceptability of rapid, point-of-care HIV testing in two clinical settings in Ghana. AIDS Patient Care STDS 2009 May;23(5):365-9.

In Context

Point-of-care (POC) testing for HIV using blood obtained from a finger stick has high sensitivity and specificity(1,2) and has become the preferred method of testing in many developed and developing countries. Using currently available tests, POC testing is affordable and easy to use and provides results in approximately 20 minutes. Rapid tests are an effective way of increasing the proportion of persons who receive their test results. Ghana, as well as other African countries, has found that a large proportion of persons who underwent conventional HIV testing did not return for their results.(3,4,5) Although studies in some parts of Africa demonstrated the high acceptability and efficacy of POC testing, these studies were not conducted in Ghana, a country with an HIV prevalence estimated at 2%-3% and where the majority of infected persons are not aware of their infection.

Objective

To assess the practicability and acceptability of POC testing using two rapid HIV tests

Setting

Two clinics within the Komfo Anokye Teaching Hospital in Kumasi, Ghana

Study Design

A cross-sectional observational study and a retrospective observational study, which provided comparison data

Participants

All patients aged 16 years or older with newly diagnosed tuberculosis (TB) who were attending TB clinic and all clients attending the HIV voluntary counseling and testing (VCT) clinic in February 2007 were tested using POC rapid tests. For comparison, data from patients aged 16 years or older who were tested using conventional HIV tests at the TB or VCT clinics from August through September 2006 were collected retrospectively.

Outcome

The proportion of patients who tested HIV-positive, the proportion who returned for test results, and the acceptability of POC testing to patients and staff at TB and VCT clinics.

Methods

Patients diagnosed with TB and clients seeking testing at the VCT clinic were offered POC testing. Before this evaluation, all newly diagnosed TB patients were offered HIV testing at the hospital but outside of the TB clinic. Subjects provided information regarding demographic characteristics and the testing process, which also was obtained from staff.

Rapid HIV testing was done using the Abbott Determine HIV-1/2 test kit in the VCT and the INSTI HIV-1/HIV-2 antibody test kit in the TB clinic. Initial results were provided in 15-20 minutes at the VCT clinic and within five minutes at the TB clinic. Persons with positive or indeterminate results were retested using a serum sample with one or two rapid tests using a combination of the Vironostika HIV-Uniform test plus 0 ELISA and ELISA/Card Test: HIV 1,2 assays. Serum samples reactive on both assays were assumed to be positive for HIV-1 or HIV-2, or both. Patients who tested positive on the rapid test were given an appointment to attend the HIV clinic within four through eight weeks.

The number of persons testing positive and the number who returned for test results within three months of testing were determined. The Student t and chi square tests were used to determine the association between demographic characteristics and HIV infection along with returning for receipt of confirmatory tests. Differences by clinic type also were measured.

Results

In February 2007, 95 VCT clinic clients and 35 TB clinic patients underwent POC testing. During the comparison period (August-September 2006) 369 (93%) of the VCT clients and 31 (41%) of the 76 TB patients were tested for HIV.

In February 2007, 37% of the VCT clients and 26% of the TB patients tested HIV-positive compared with 52% of the VCT clients and 35% of the TB patients tested between August and September 2006. All persons who underwent POC testing received their test results compared with 60% of the VCT clients and 90% of the TB patients who were tested with conventional HIV tests.

There were 78 subjects who provided feedback on the testing procedures, and the majority viewed the test positively, would recommend the test to others, and felt that providing test results quickly caused less worry than conventional testing. Feedback from staff regarding the POC testing also was positive.

Conclusions

Rapid POC testing, which provides results quickly while the tested person waits, was feasible and acceptable in these two clinic populations and resulted in a higher proportion of persons receiving their test results than did conventional testing, in which patients were required to return for results.

Quality rating

This study was of fair quality. The representativeness of the TB patient and VCT clinic populations could not be determined and the proportion of persons offered and accepting testing during the retrospective study was low and therefore not comparable to the prospective study. The differences between VCT client and TB patient populations were fewer than differences between study periods. The number of participants who completed the questionnaire regarding the POC testing experience was low and therefore might not be representative of all persons who underwent the procedures.

Programmatic implications

This study found that POC testing could be provided at TB and VCT clinics and that the level of acceptability among patients and staff appears high. In this study, rapid testing was not used to confirm preliminary positive or indeterminate results, which is the standard of care elsewhere.(1) As such, the testing methods employed are not representative of the standard POC testing, thereby minimizing their usefulness. The study did confirm, however, that a large proportion of persons tested conventionally did not receive their test results, providing additional support for the value of POC testing. At this point, the evidence in favor of POC testing, including confirmatory testing, is strong.

References

  1. Plate DK, Rapid HIV Test Evaluation Working Group. Evaluation and implementation of rapid HIV tests: The experience in 11 African countries. AIDS Res Hum Retroviruses 2007;23:1491-8.
  2. Burrage J Jr. HIV rapid tests: Progress, perspective, and future directions. Clin J Oncol Nurs 2003;7:207-8.
  3. Downing RG, Otten RA, Marum E, et al. Optimizing the delivery of HIV counselling and testing services: The Uganda experience using rapid HIV antibody test algorithms. J Acquir Immune Defic Syndr Hum Retrovirol 1998;18:384-8.
  4. Germano FN, da Silva TM, Mendoza-Sassi R, et al. [High prevalence of users who did not return to the Testing and Counseling Center (TCC) for knowing their serological status: Rio Grande, RS, Brazil.] Cien Saude Colet 2008;13:1033-40. In Portuguese.
  5. Mkwanazi NB, Patel D, Newell ML, et al. Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: A cohort study of 12,000 women. PLoS ONE 2008;3:e3501.