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Riegler AN, Larsen N, Amerson-Brown MH. Point-of-Care Testing for Sexually Transmitted Infections. Clin Lab Med 2023; 43:189-207. [PMID: 37169442 DOI: 10.1016/j.cll.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.
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Affiliation(s)
- Ashleigh N Riegler
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Natalie Larsen
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Megan H Amerson-Brown
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA.
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Bile EC, Bachanas PJ, Jarvis JN, Maurice F, Makovore V, Chebani L, Jackson KG, Birhanu S, Maphorisa C, Mbulawa MB, Alwano MG, Sexton C, Modise SK, Bapati W, Segolodi T, Moore J, Fonjungo PN. Accuracy of point-of-care HIV and CD4 field testing by lay healthcare workers in the Botswana Combination Prevention Project. J Virol Methods 2023; 311:114647. [PMID: 36343742 DOI: 10.1016/j.jviromet.2022.114647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
Accurate HIV and CD4 testing are critical in program implementation, with HIV misdiagnosis having serious consequences at both the client and/or community level. We implemented a comprehensive training and Quality Assurance (QA) program to ensure accuracy of point-of-care HIV and CD4 count testing by lay counsellors during the Botswana Combination Prevention Project (BCPP). We compared the performance of field testing by lay counsellors to results from an accredited laboratory to ascertain accuracy of testing. All trained lay counsellors passed competency assessments and performed satisfactorily in proficiency testing panel evaluations in 2013, 2014, and 2015. There was excellent agreement (99.6 %) between field and laboratory-based HIV test results; of the 3002 samples tested, 960 and 2030 were concordantly positive and negative respectively, with 12 misclassifications (kappa score 0.99, p < 0.0001). Of the 149 HIV-positive samples enumerated for CD4 count in the field using PIMA at a threshold of ≤ 350 cells/µl; there was 86 % agreement with laboratory testing, with only 21 misclassified. The mean difference between field and lab CD4 testing was - 16.16 cells/µl (95 % CI -5.4 to 26.9). Overall, there was excellent agreement between field and laboratory results for both HIV rapid test and PIMA CD4 results. A standard training package to train lay counsellors to accurately perform HIV and CD4 point-of-care testing in field settings was feasible, with point-of-care results obtained by lay counsellors comparable to laboratory-based testing.
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Affiliation(s)
- Ebi C Bile
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Pamela J Bachanas
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Joseph N Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona Maurice
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Vongai Makovore
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Liziwe Chebani
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Keisha G Jackson
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Sehin Birhanu
- US Centers for Disease Control and Prevention Atlanta, United States
| | | | - Mpaphi B Mbulawa
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Mary Grace Alwano
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Connie Sexton
- US Centers for Disease Control and Prevention Atlanta, United States
| | | | - William Bapati
- Tebelopele Counseling and Testing Center, Gaborone, Botswana
| | - Tebogo Segolodi
- US Centers for Disease Control and Prevention Botswana (CDC Botswana), Gaborone, Botswana
| | - Janet Moore
- US Centers for Disease Control and Prevention Atlanta, United States
| | - Peter N Fonjungo
- US Centers for Disease Control and Prevention Atlanta, United States.
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Schmitz ME, Chang K, Arnett N, Kohatsu L, Lemwayi R, Mwasekaga M, Nkengasong J, Bolu O, Mosha F, Westerman L. Onsite healthcare worker acceptability and performance of the point-of-care Pima CD4 assay in Dar es Salaam, Tanzania. Afr J Lab Med 2019; 8:740. [PMID: 31824830 PMCID: PMC6890544 DOI: 10.4102/ajlm.v8i1.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/21/2019] [Indexed: 11/01/2022] Open
Abstract
Background: Healthcare workers’ acceptance of and ability to perform point-of-care testing is important for reliable and accurate results. The Alere Pima™ CD4 assay (Pima CD4) is the CD4 point-of-care test for HIV management in Tanzania.Objectives: To evaluate healthcare workers’ acceptance and performance of Pima CD4 testing.Methods: The study was implemented in five high volume sites in Dar es Salaam, Tanzania, in 2011. Trained healthcare workers performed Pima testing using three whole-blood specimens collected from each patient: venous blood, fingerstick blood directly applied to a Pima cartridge (capillary-direct), and fingerstick blood collected in a microtube (capillary-microtube). Using a semi-structured interview guide, we interviewed 11 healthcare workers about specimen collection methods and Pima CD4 acceptability. Quantitative responses were analysed using descriptive statistics. Open-ended responses were summarised by thematic areas. Pima CD4 results were analysed to determine variation between cadres.Results: Healthcare workers found Pima CD4 user-friendly and recommended its use in low volume, peripheral facilities. Both venous and capillary-direct blood were considered easy to collect, with venous preferred. Advantages noted with venous and capillary-microtube methods were the ability to retest, perform multiple tests, or delay testing. Pima CD4 results were trusted by the healthcare workers and were in agreement with laboratory Pima testing.Conclusion: In this point-of-care testing setting, the Pima CD4 assay was accepted by healthcare workers. Both venous and fingerstick capillary blood specimens can be used with Pima CD4, but fingerstick methods may require more intensive training on technique to minimise variation in results and increase acceptability.
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Affiliation(s)
- Mary E Schmitz
- United States Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
- ASPH/CDC Allan Rosenfield Global Health, Dar es Salaam, United Republic of Tanzania
| | - Karen Chang
- United States Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
- ASPH/CDC Allan Rosenfield Global Health, Dar es Salaam, United Republic of Tanzania
| | - Nichole Arnett
- Division of Global HIV and TB, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Luciana Kohatsu
- Division of Global HIV and TB, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Ruth Lemwayi
- African Field Epidemiology Network (AFENET), Dar es Salaam, United Republic of Tanzania
| | - Michael Mwasekaga
- United States Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - John Nkengasong
- Division of Global HIV and TB, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Omotayo Bolu
- Division of Global HIV and TB, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Fausta Mosha
- African Field Epidemiology Network (AFENET), Dar es Salaam, United Republic of Tanzania
- Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
| | - Larry Westerman
- Division of Global HIV and TB, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Vojnov L, Taegtmeyer M, Boeke C, Markby J, Harris L, Doherty M, Peter T, Ford N. Performance of non-laboratory staff for diagnostic testing and specimen collection in HIV programs: A systematic review and meta-analysis. PLoS One 2019; 14:e0216277. [PMID: 31048881 PMCID: PMC6497381 DOI: 10.1371/journal.pone.0216277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In most high HIV burden countries, many HIV patients do not have reliable access to required diagnostic laboratory tests. Task shifting of clinical tasks to lower cadres of health care workers and lay counselors has been successful in scaling up treatment for HIV and may also be an effective strategy in expanding access to essential diagnostic testing. METHODS We screened major electronic databases between 1 January 2005 to 26 August 2018 to identify studies assessing ease of use and accuracy of task shifting of HIV-related diagnostic testing and/or specimen collection to non-laboratory health staff. Two independent reviewers screened all titles and abstracts for studies that analyzed diagnostic accuracy, patient impact, ease-of-use, or cost-effectiveness. Studies were assessed for quality, bias, and applicability following the QUADAS-2 framework. We generated summary estimates using random-effects meta-analyses. RESULTS We identified 42 relevant studies. Overall, point-of-care CD4 testing performed by non-laboratory staff had a mean bias of -54.44 (95% CI: -72.40 --36.48) compared to conventional laboratory-based. Though studies were limited, the diagnostic accuracy of point-of-care alanine transaminase enzyme (ALT) and hemoglobin testing performed by non-laboratory staff was comparable to conventional laboratory-based testing by laboratory professionals. Point-of-care testing and/or specimen collection were generally found to be acceptable and easy to use for non-laboratory staff. CONCLUSIONS Task shifting of testing using point-of-care technologies to non-laboratory staff was comparable to laboratory professionals operating the same technology in the laboratory. Some variability was observed comparing the performance of point-of-care CD4 testing by non-laboratory staff to conventional laboratory-based technologies by laboratory professionals indicating potential lower performance was likely technological rather than operator caused. The benefits of task shifting of testing may outweigh any possible harms as task shifting allows for increased decentralization, access of specific diagnostics, and faster result delivery.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Jessica Markby
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Lindsay Harris
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Nathan Ford
- World Health Organization, Geneva, Switzerland
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