Trial reportJournal of the International AIDS Society2017
Understanding low sensitivity of community-based HIV rapid testing: experiences from the HPTN 071 (PopART) trial in Zambia and South Africa.
Trial report in Journal of the International AIDS Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01900977 (Population Effects of Antiretroviral Therapy to Reduce HIV Transmission), which is not on this map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART): A Cluster-randomized Trial of the Impact of a Combination Prevention Package on Population-level HIV Incidence in Zambia and South Africa
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status.Journal of the International AIDS Society · 2017Pooled it
- Trial
- HIV Care Cascade Among Adolescents in a "Test and Treat" Community-Based Intervention: HPTN 071 (PopART) for Youth Study.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2021Trial
- Understanding the Time Needed to Link to Care and Start ART in Seven HPTN 071 (PopART) Study Communities in Zambia and South Africa.AIDS and behavior · 2019Trial
- Evaluating the sensitivity and specificity of Determine™ HIV-1/2 rapid test using a 0.01M phosphate-buffered saline produced at the Medical Research Council Unit The Gambia for the diagnosis of HIV.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2024Article
- Real-world performance of point-of-care vs. standard-of-care HIV viral load testing in western Kenya: Secondary analysis of Opt4Kids and Opt4Mamas studies.PLOS global public health · 2024Article
- Temporal discrepancies in "rapid" HIV testing: explaining misdiagnoses at the point-of-care in Zimbabwe.BMC infectious diseases · 2023Article
- Sensitivity and specificity of OraQuick® HIV self-test compared to a 4th generation laboratory reference standard algorithm in urban and rural Zambia.BMC infectious diseases · 2022Article
- Comprehensive investigation of sources of misclassification errors in routine HIV testing in Zimbabwe.Journal of the International AIDS Society · 2021Article
- Does antiretroviral therapy use affect the accuracy of HIV rapid diagnostic assays? Experience from a demographic health and surveillance site in rural South Africa.Diagnostic microbiology and infectious disease · 2020Article
- Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials.Current HIV/AIDS reports · 2020Review
- Determination of HIV status and identification of incident HIV infections in a large, community-randomized trial: HPTN 071 (PopART).Journal of the International AIDS Society · 2020Article
- Clinical staff knowledge and awareness of point-of-care-testing best practices at Tygerberg Hospital, South Africa.African journal of laboratory medicine · 2020Article
- National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the 'first 90' from program and survey data.AIDS (London, England) · 2019Article
- Treatment as Prevention: Concepts and Challenges for Reducing HIV Incidence.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA).Journal of the International AIDS Society · 2019Article
- Article
- Article
- External quality assessment for HIV rapid tests: challenges and opportunities in Haiti.BMJ global health · 2018Article
- A public health approach to addressing and preventing misdiagnosis in the scale-up of HIV rapid testing programmes.Journal of the International AIDS Society · 2017Article
Corrections and comments
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Authors and funding
18 authors.
Funding
Abstract
introductionPopulation-wide HIV testing services (HTS) must be delivered in order to achieve universal antiretroviral treatment (ART) coverage. To accurately deliver HTS at such scale, non-facility-based HIV point-of-care testing (HIV-POCT) is necessary but requires rigorous quality assurance (QA). This study assessed the performance of community-wide HTS in Zambia and South Africa (SA) as part of the HPTN 071 (PopART) study and explores the impact of quality improvement interventions on HTS performance.
methodsBetween 2014 and 2016, HIV-POCT was undertaken within households both as part of the randomly selected HPTN 071 research cohort (Population Cohort [PC]) and as part of the intervention provided by community HIV-care providers. HIV-POCT followed national algorithms in both countries. Consenting PC participants provided a venous blood sample in addition to being offered HIV-POCT. We compared results obtained in the PC using a laboratory-based gold standard (GS) testing algorithm and HIV-POCT. Comprehensive QA mechanisms were put in place to support the community-wide testing. Participants who were identified as having a false negative or false positive HIV rapid test were revisited and offered retesting.
resultsWe initially observed poor sensitivity (45-54%, 95% confidence interval [CI] 31-69) of HIV-POCT in the PC in SA compared to sensitivity in Zambia for the same time period of 95.8% (95% CI 93-98). In both countries, specificity of HIV-POCT was >98%. With enhanced QA interventions and adoption of the same HIV-POCT algorithm, sensitivity in SA improved to a similar level as in Zambia.
conclusionsThis is one of the first reports of HIV-POCT performance during wide-scale delivery of HTS compared to a GS laboratory algorithm. HIV-POCT in a real-world setting had a lower sensitivity than anticipated. Appropriate choice of HIV-POCT algorithms, intensive training and supervision, and robust QA mechanisms are necessary to optimize HIV-POCT test performance when testing is delivered at a community level. HIV-POCT in clients who did not disclose that they were on ART may have contributed to false negative HIV-POCT results and should be the topic of future research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.