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首页> 美国卫生研究院文献>Journal of the International AIDS Society >A Commitment to HIV Diagnostic Accuracy – a comment on Towards more accurate HIV testing in sub‐Saharan Africa: a multi‐site evaluation of HIV RDTs and risk factors for false positives ‘and’ HIV misdiagnosis in sub‐Saharan Africa: a performance of diagnostic algorithms at six testing sites
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A Commitment to HIV Diagnostic Accuracy – a comment on Towards more accurate HIV testing in sub‐Saharan Africa: a multi‐site evaluation of HIV RDTs and risk factors for false positives ‘and’ HIV misdiagnosis in sub‐Saharan Africa: a performance of diagnostic algorithms at six testing sites

机译：对艾滋病毒诊断准确性的承诺–评论在撒哈拉以南非洲地区进行更准确的艾滋病毒检测：对撒哈拉以南非洲地区的HIV RDTs和误报风险和HIV误诊的危险因素进行多点评估：六个测试点的诊断算法

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As part of the global response to the HIV/AIDS epidemic, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is committed to the provision of high‐quality services and ensuring testing accuracy. Two recently published papers focusing on HIV testing and misdiagnosis in sub‐Saharan Africa by Kosack et al. report on evaluations of HIV rapid diagnostic tests (RDTs) and found lower than expected specificity and sensitivity on some tests when used in certain geographic locations. The magnitude of PEPFAR's global HIV response has been possible due to the extensive use of RDTs, which have made HIV diagnosis accessible all over the world. We take the opportunity to address concerns raised about the potential implications that these findings could have on real‐world HIV testing accuracy. PEPFAR supported countries adhere to the normative guidance by World Health Organization (WHO) supporting algorithms which require sequential positive tests for diagnostic accuracy. An analysis of Médecins Sans Frontières (MSF) RDT site‐specific data applied to style="fixed-case">PEPFAR in‐country protocols demonstrate a variation in the diagnostic accuracy of the testing algorithms, but with a very small population‐level effect. The data demonstrate, with the use of these algorithms, that the style="fixed-case">RDT outcomes found in the study by Kosack et al. would be largely mitigated and would not be expected to have a significant impact on diagnostic accuracy and overall programming in most countries. Avoiding any misdiagnosis is a priority for style="fixed-case">PEPFAR, and it remains vital to gain a deeper understanding of the causes and the extent of diagnostic errors and any misclassification. Extensive quality control mechanisms and continued research are essential. With a focus on epidemic control and ensuring diagnostic accuracy, style="fixed-case">PEPFAR recommends that all countries use style="fixed-case">WHO pre‐qualified style="fixed-case">RDTs within the recommended strategies and algorithms for style="fixed-case">HIV testing. We also support validation of style="fixed-case">HIV testing algorithms using in‐country specimens to determine optimal performance, and the reverification testing of all people diagnosed with style="fixed-case">HIV prior to starting treatment as an essential quality assurance measure.
机译：作为对艾滋病毒/艾滋病流行病全球应对措施的一部分，美国总统艾滋病紧急救援计划（PEPFAR）致力于提供高质量的服务并确保检测的准确性。 Kosack等人最近发表了两篇论文，重点关注撒哈拉以南非洲的艾滋病毒检测和误诊。报告对HIV快速诊断检测（RDT）进行评估，发现在某些地理位置使用某些检测时，其特异性和敏感性低于预期。由于RDT的广泛使用，PEPFAR在全球的艾滋病毒应对工作之所以成为可能，是因为全世界都可以使用HIV诊断。我们借此机会解决有关这些发现可能对现实世界中HIV检测准确性产生的潜在影响的担忧。 PEPFAR支持的国家遵守世界卫生组织（WHO）支持算法的规范指南，该算法要求对诊断准确性进行连续的阳性测试。对适用于 style =“ fixed-case”> PEPFAR 国内协议的MédecinsSansFrontières（MSF）RDT站点特定数据的分析表明，测试算法的诊断准确性有所不同，但是人口层面的影响很小。数据表明，通过使用这些算法，Kosack等人的研究发现了 style =“ fixed-case”> RDT 结果。在大多数国家，这种方法将大大缓解，并且不会对诊断准确性和整体编程产生重大影响。避免任何误诊是 style =“ fixed-case”> PEPFAR 的优先事项，对于更深入地了解诊断错误的原因和程度以及任何错误分类，这仍然至关重要。广泛的质量控制机制和持续的研究至关重要。 style =“ fixed-case”> PEPFAR 着眼于流行病控制并确保诊断的准确性，建议所有国家/地区使用经过资格预审的 style =“ fixed-case”> WHO <在 style =“ fixed-case”> HIV 测试的推荐策略和算法中使用“ span style =“ fixed-case”> RDT ”。我们还支持使用国内标本对 style =“ fixed-case”> HIV 测试算法进行验证，以确定最佳性能，并支持对所有诊断为 style =“ fixed-case”的人进行再验证测试开始治疗前将> HIV 作为一项基本的质量保证措施。

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