Performance of HIV rapid testing algorithm in Nigeria: Findings from a household-based Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS)

Hetal K Patel, Sunday Ikpe, Megan Bronson, Sehin Birhanu, Alash’le Abimiku, Ibrahim Jahun, Mervi Detorio, Kathryn Lupoli, Daniel Yavo, Orji O Bassey, Tapdiyel D Jelpe, Brian Kagurusi, Nnaemeka C Iriemenam, Divya Patel, McPaul I Okoye, Ibrahim T Dalhatu, Stephen Ohakanu, Andrew C Voetsch, Sani Aliyu, Gregory Ashefor, Aliyu Gambo, Gabriel O Ikwulono, Charles Nzelu, Isaac F Adewole, Mahesh Swaminathan and Bharat Parekh

PLOS Global Public Health, 2022, vol. 2, issue 7, 1-6

Abstract: Background: The Nigeria AIDS Indicator and Impact Survey (NAIIS), a cross-sectional household survey, was conducted in 2018 with primary objectives to estimate HIV prevalence, HIV-1 incidence, and status of UNAIDS 90-90-90 cascade. We conducted retrospective analysis of the performance of HIV rapid tests and the national HIV testing algorithm used in Nigeria. Methods: The national algorithm included Determine HIV-1/2 as test 1 (T1), Unigold HIV-1/2 as test 2 (T2), and StatPak HIV-1/2 as the tie-breaker test (T3). Individuals reactive with T1 and either T2 or T3 were considered HIV-positive. HIV-positive specimens from the algorithm were further confirmed for the survey using supplemental test Geenius HIV-1/2. If Geenius did not confirm HIV-positive status, HIV-1 Western blot was performed. We calculated the concordance between tests and positive predictive value (PPV) of the algorithm on unweighted data. Results: Of 204,930 participants (ages ≥18 months) 5,103 (2.5%) were reactive on T1. Serial testing of T1 reactive specimens with T2 or if needed by tiebreaker T3 identified 2958 (1.44%) persons as HIV-positive. Supplemental testing confirmed 2,800 (95%) as HIV-positive (HIV-1 = 2,767 [98.8%]; HIV-2 = 5 [0.2%]; dual infections = 22 [0.8%]). Concordance between T1 and T2 was 56.6% while PPV of the national algorithm was 94.5%. Conclusions: Our results show high discordant rates and poor PPV of the national algorithm with a false-positive rate of about 5.5% in the NAIIS survey. Considering our findings have major implications for HIV diagnosis in routine HIV testing services, additional evaluation of testing algorithm is warranted in Nigeria.

Date: 2022
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0000466

DOI: 10.1371/journal.pgph.0000466

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