1
|
Huang YF, Pan LC, Yang JY, Liao YH, Su HJ, Mei NH, Lin SP, Shen JH, Tsai YC. Assessment of the performance regarding confirmatory diagnosis and initiation of antiretroviral therapy under a modified national HIV testing algorithm and pay-for-performance program in Taiwan. J Microbiol Immunol Infect 2023; 56:1139-1146. [PMID: 37735047 DOI: 10.1016/j.jmii.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND A pay-for-performance plan for rapid antiretroviral therapy (ART) commencement was initiated in 2018, while a modified testing algorithm offers immunochromatographic test (ICT) to replace Western blot (WB), and simultaneous testing with ICT and Nucleic Acid Amplification Test (NAAT) for HIV-positive sera was adopted in 2019 in Taiwan. METHODS Serum specimens collected from 1117 suspected or confirmed HIV infection cases in 2016-2019 were reassessed the performance of WB, ICT, and NAAT. We reviewed the medical records of 10,732 individuals diagnosed with HIV in 2015-2021 to determine the time from screening to confirmatory diagnosis, followed by ART commencement. RESULTS All 860 WB-positives were also positive by ICT and NAAT. The positive detection percentages were 37.0% by ICT and 51.4% by NAAT for 257 WB-indeterminate and -negative sera. The sensitivity for WB and ICT was 93.8% and 95.5%, respectively. In the people living with HIV (PLHIV) cohort, the median time from initial positive to confirmatory diagnosis decreased from 5 to 6 days before 2019 to 1 day in 2021. The median time from initial positive to ART initiation decreased from 37 days in 2015, 14 days in 2018, to 6 days in 2021. Compared to 2015-2017, the time to ART initiation was 91.48 days lower in 2018 (P < 0.001) and 100.66 days lower in 2019-2021 (P < 0.001) by the adjusted linear regression model. CONCLUSION A significant decrease in the time to ART initiation was observed after initiation of the pay-for-performance program and optimized testing algorithm in Taiwan.
Collapse
Affiliation(s)
- Yen-Fang Huang
- Research Center for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Preparedness and Emerging Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan.
| | - Li-Chern Pan
- Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, Taipei, Taiwan.
| | - Jyh-Yuan Yang
- Center for Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Taipei, Taiwan.
| | - Yu-Hsin Liao
- Center for Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Taipei, Taiwan.
| | - Hsin-Jou Su
- Division of Chronic Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan.
| | - Nai-Hwa Mei
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shiou-Pin Lin
- Research Center for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Jen-Hsiu Shen
- Division of Chronic Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan.
| | - Yi-Chen Tsai
- Division of Chronic Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan.
| |
Collapse
|
2
|
Gulinaizhaer A, Zou M, Ma S, Yao Y, Fan X, Wu G. Isothermal nucleic acid amplification technology in HIV detection. Analyst 2023; 148:1189-1208. [PMID: 36825492 DOI: 10.1039/d2an01813f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Nucleic acid testing for HIV plays an important role in the early diagnosis and monitoring of antiretroviral therapy outcomes in HIV patients and HIV-infected infants. Currently, the main molecular diagnostic methods employed are complex, time-consuming, and expensive to operate in resource-limited areas. Isothermal nucleic acid amplification technology overcomes some of the shortcomings of traditional assays and makes it possible to use point-of-care tests for molecular HIV detection. Here, we summarize and discuss the latest technological advances in isothermal nucleic acid amplification for HIV detection, with the intent of providing guidance for the development of subsequent HIV assays with high sensitivity and specificity.
Collapse
Affiliation(s)
- Abudushalamu Gulinaizhaer
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.,Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China.
| | - Mingyuan Zou
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.,Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China.
| | - Shuo Ma
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.,Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China.
| | - Yuming Yao
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.,Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China.
| | - Xiaobo Fan
- Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China.
| | - Guoqiu Wu
- Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.,Department of Laboratory Medicine, Medical School of Southeast University, Nanjing 210009, Jiangsu, China. .,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Southeast University, Nanjing 210009, Jiangsu, China
| |
Collapse
|
3
|
Patel HK, Ikpe S, Bronson M, Birhanu S, Abimiku A, Jahun I, Detorio M, Lupoli K, Yavo D, Bassey OO, Jelpe TD, Kagurusi B, Iriemenam NC, Patel D, Okoye MI, Dalhatu IT, Ohakanu S, Voetsch AC, Aliyu S, Ashefor G, Gambo A, Ikwulono GO, Nzelu C, Adewole IF, Swaminathan M, Parekh B. Performance of HIV rapid testing algorithm in Nigeria: Findings from a household-based Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). PLOS Glob Public Health 2022; 2:e0000466. [PMID: 36962526 PMCID: PMC10021238 DOI: 10.1371/journal.pgph.0000466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022]
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.
Collapse
Affiliation(s)
- Hetal K Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sunday Ikpe
- University of Maryland School of Medicine Institute of Human Virology, Baltimore, Maryland, United States of America
| | - Megan Bronson
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sehin Birhanu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alash'le Abimiku
- University of Maryland School of Medicine Institute of Human Virology, Baltimore, Maryland, United States of America
| | - Ibrahim Jahun
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mervi Detorio
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn Lupoli
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel Yavo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Orji O Bassey
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tapdiyel D Jelpe
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brian Kagurusi
- University of Maryland School of Medicine Institute of Human Virology, Baltimore, Maryland, United States of America
| | - Nnaemeka C Iriemenam
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Divya Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - McPaul I Okoye
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ibrahim T Dalhatu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen Ohakanu
- University of Maryland School of Medicine Institute of Human Virology, Baltimore, Maryland, United States of America
| | - Andrew C Voetsch
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sani Aliyu
- Nigeria AIDS Control Agency, Abuja, Nigeria
| | | | | | | | | | - Isaac F Adewole
- Federal Ministry of Health, Abuja, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat Parekh
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
4
|
Duncan D, Duncan J, Kramer B, Nilsson AY, Haile B, Butcher A, Chugh S, Baum P, Aldrovandi GM, Young S, Avery AK, Tashima K, Valsamakis A, Yao JD, Chang M, Coombs RW. An HIV Diagnostic Testing Algorithm Using the cobas HIV-1/HIV-2 Qualitative Assay for HIV Type Differentiation and Confirmation. J Clin Microbiol 2021; 59:e0303020. [PMID: 33853869 DOI: 10.1128/JCM.03030-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) diagnostic testing algorithms recommended by the Centers for Disease Control involve up to three tests and rely mostly on detection of viral antigen and host antibody responses. HIV-1 p24 antigen/HIV-1/HIV-2 antibody-reactive specimens are confirmed with an immunochromatographic HIV-1/HIV-2 antibody differentiation assay, and negative or indeterminate results from the differentiation assay are resolved by an HIV-1-specific nucleic acid amplification test (NAT). The performance of a proposed alternative algorithm using the cobas HIV-1/HIV-2 qualitative NAT as the differentiation assay was evaluated in subjects known to be infected with HIV-1 (n = 876) or HIV-2 (n = 139), at low (n = 6,017) or high (n = 1,020) risk of HIV-1 infection, or at high-risk for HIV-2 infection (n = 498) (study A). The performance of the cobas HIV-1/HIV-2 qualitative test was also evaluated by comparison to an HIV-1 or HIV-2 alternative NAT (study B). The HIV-1 and HIV-2 overall percent agreements (OPA) in study A ranged from 95% to 100% in all groups. The positive percent agreements (PPA) for HIV-1 and HIV-2 were 100% (876/876) and 99.4% (167/168), respectively, for known positive groups. The negative percent agreement in the HIV low-risk group was 100% for both HIV-1 and HIV-2. In study B, the HIV-1 and HIV-2 OPA ranged from 99% to 100% in all groups evaluated (n = 183 to 1,030), and the PPA for HIV-1 and HIV-2 were 100% and 99.5%, respectively, for known positive groups. The cobas HIV-1/HIV-2 qualitative assay can discriminate between HIV-1 and HIV-2 based on HIV RNA and can be included in an alternative diagnostic algorithm for HIV.
Collapse
|