73K people may be misclassified as HIV-positive in 11 African countries
ATLANTA — Approximately 73,000 people in 11 sub-Saharan African countries may be misclassified as being HIV-positive, including many who may have unnecessarily started ART, according to data presented at the Epidemic Intelligence Service, or EIS, conference.
The findings originated from a survey of more than 220,000 patients self-reporting as HIV-positive in Cameroon, eSwatini, Ethiopia, Ivory Coast, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia and Zimbabwe.
“The issue of potential HIV misdiagnosis became apparent when we identified participants who told us they were HIV-positive but then tested HIV-negative during our survey’s household field testing. We decided to investigate the extent of the problem further using combined data from 11 countries.” Naeemah Logan, MD, an EIS officer in the CDC’s Division of Global HIV and Tuberculosis, told Infectious Disease News.
Logan and colleagues surveyed participants aged 15 years and older using a standard questionnaire to determine HIV testing history and self-reported status and then tested them for HIV infection using HIV rapid-diagnostic tests. Participants who self-reported being HIV-positive but tested HIV-negative underwent confirmatory testing, then DNA PCR testing in a lab if further tests also were negative.
Results showed that among 221,941 participants surveyed, 198 self-reported as HIV-positive but tested HIV-negative. Among them, 67.7% were female, 44.9% were aged 15 to 29 years, 64.6% lived in rural settings and 24.7% reported currently taking ART.
Logan and colleagues estimated that, although a relatively small percentage of participants said they were HIV-positive but had a negative HIV test, extrapolated to fit the overall HIV burden in the 11 countries, they estimated that approximately 73,000 people were potentially misclassified as HIV-positive in those countries and that nearly 29,000 people may have inappropriately started ART.
“False positive results with HIV rapid diagnostic tests have been reported and attributed to a variety of causes, including participants’ misunderstanding of previous HIV testing results, participant misreporting HIV status during the PHIA survey, or HIV testing error,” Logan said.
“Considering the resources needed to care for people who are HIV positive, and the side effects of being inappropriately treated for HIV, our study underscores the importance of quality assurance in testing and clear counselling about HIV test results.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
Reference: Logan N, et al. Self-Reported HIV-positive status but subsequent HIV-negative test results in Population-Based HIV Impact Assessment (PHIA) survey participants — 11 Sub-Saharan African countries, 2015–2017; Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.