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首页> 外文期刊>Journal of the International Aids Society >HIV misdiagnosis in sub‐Saharan Africa: performance of diagnostic algorithms at six testing sites
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HIV misdiagnosis in sub‐Saharan Africa: performance of diagnostic algorithms at six testing sites

机译：撒哈拉以南非洲地区的艾滋病毒误诊：在六个测试点执行诊断算法

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Introduction: We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub‐Saharan African countries. Methods: In this prospective multisite diagnostic evaluation study (Conakry, Guinea; Kitgum, Uganda; Arua, Uganda; Homa Bay, Kenya; Doula, Cameroun and Baraka, Democratic Republic of Congo), samples from clients (greater than equal to five years of age) testing for HIV were collected and compared to a state‐of‐the‐art algorithm from the AIDS reference laboratory at the Institute of Tropical Medicine, Belgium. The reference algorithm consisted of an enzyme‐linked immuno‐sorbent assay, a line‐immunoassay, a single antigen‐enzyme immunoassay and a DNA polymerase chain reaction test. Results: Between August 2011 and January 2015, over 14,000 clients were tested for HIV at 6 HIV counselling and testing sites. Of those, 2786 (median age: 30; 38.1% males) were included in the study. Sensitivity of the testing algorithms ranged from 89.5% in Arua to 100% in Douala and Conakry, while specificity ranged from 98.3% in Doula to 100% in Conakry. Overall, 24 (0.9%) clients, and as many as 8 per site (1.7%), were misdiagnosed, with 16 false‐positive and 8 false‐negative results. Six false‐negative specimens were retested with the on‐site algorithm on the same sample and were found to be positive. Conversely, 13 false‐positive specimens were retested: 8 remained false‐positive with the on‐site algorithm. Conclusions: The performance of algorithms at several sites failed to meet expectations and thresholds set by the World Health Organization, with unacceptably high rates of false results. Alongside the careful selection of rapid diagnostic tests and the validation of algorithms, strictly observing correct procedures can reduce the risk of false results. In the meantime, to identify false‐positive diagnoses at initial testing, patients should be retested upon initiating antiretroviral therapy.
机译：简介：我们在五个撒哈拉以南非洲国家的六个项目中评估了HIV检测算法的诊断准确性。方法：在这项前瞻性多站点诊断评估研究中（几内亚的科纳克里，乌干达的基特古姆，乌干达的阿鲁阿，肯尼亚的霍马湾，刚果民主共和国的杜拉，喀麦隆和巴拉卡），从客户那里取样（大于等于五年）收集了针对HIV的检测，并与比利时热带医学研究所AIDS参考实验室的最新算法进行了比较。参考算法包括酶联免疫吸附测定，线免疫测定，单抗原-酶免疫测定和DNA聚合酶链反应测试。结果：2011年8月至2015年1月，在6个HIV咨询和检测点对14,000多名客户进行了HIV检测。其中，研究中包括2786名（中位年龄：30;男性为38.1％）。测试算法的灵敏度范围从Arua的89.5％到Douala和Conakry的100％，而特异性从Doula的98.3％到Conakry的100％不等。总体而言，有24（0.9％）位客户被误诊，每个站点多达8位（1.7％）被误诊，结果有16例假阳性和8例假阴性。使用现场算法对同一样本重新测试了六个假阴性样本，发现它们均为阳性。相反，对13个假阳性标本进行了重新测试：使用现场算法，有8个假阳性标本。结论：在几个站点的算法性能未能达到世界卫生组织设定的期望和阈值，错误结果的发生率高得令人无法接受。除了精心选择快速诊断测试和算法验证外，严格遵守正确的程序可以降低错误结果的风险。同时，为了在初次测试中发现假阳性诊断，应在开始抗逆转录病毒治疗后对患者进行重新测试。

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