Accuracy and costs of rapid human immunodeficiency virus testing technologies in rural hospitals in Zambia
Plourde, P.J.; Mphuka, S.; Muyinda, G.K.; Banda, M.; Sichali-Sichinga, K.; Chama, D.; Ronald, A.R.
Sexually Transmitted Diseases 25(5): 254-259
1998
ISSN/ISBN: 0148-5717 PMID: 9587177 DOI: 10.1097/00007435-199805000-00007Document Number: 273906
Objective: To evaluate the accuracy and costs of newer rapid human immunodeficiency virus (HIV) antibody tests in primary health care settings in rural Zambia. Methods: Three rural hospitals participated in this study. During a baseline assessment period, HIV testing practices were recorded on 250 consecutive clients at each hospital. Baseline evaluation was compared with 250 subsequent consecutive clients tested using a testing algorithm consisting of an initial screening HIV Dipstick test (McDonald Scientific (PVT) Limited, Harare, Zimbabwe) followed by confirmatory testing of all reactive specimens using the HIV Capillus test (Cambridge Diagnostics, Galway, Ireland), in conformity with World Health Organization HIV testing recommendations. Quality control was performed at a national university teaching hospital laboratory. Results: A total of 1,500 clients was entered, with an HIV seropositivity rate of 53.2%. Most HIV testing was performed on patients with signs and symptoms suggestive of HIV infection. Same-day results were provided for only 16%. The HIV Dipstick testing algorithm sensitivity was 96.9%, and specificity was 98.0%. Counselor dissatisfaction was greater with the Dipstick algorithm as a result of 5.3% discordant results. Use of the HIV Dipstick testing algorithm cost between USdollar sign3.00 and USdollar sign3.80 per client tested. Conclusions: The accuracy of HIV testing in unsophisticated rural laboraties in Zambia is acceptable. Although HIV Dipstick testing algorithm costs were relatively high for a developing country, this testing procedure is currently the most economical method available in Zambia. Accurate, less costly HIV testing algorithms are still needed.