Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Dec;93(S4):S3-S15.
doi: 10.1136/sextrans-2016-053069. Epub 2017 Jul 26.

A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis

Harriet D Gliddon  1 , Rosanna W Peeling  2 , Mary L Kamb  3 , Igor Toskin  4 , Teodora E Wi  4 , Melanie M Taylor  4
Affiliations
Meta-Analysis

A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis

Harriet D Gliddon et al. Sex Transm Infect. 2017 Dec.

Abstract

Background: Mother-to-child transmission (MTCT) of syphilis and HIV continue to be important yet preventable causes of perinatal and infant morbidity and mortality.

Objectives: To systematically review, critically appraise and perform a meta-analysis to evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use.

Design: Systematic review and meta-analysis.

Data sources: We searched seven electronic bibliographic databases from 2012 to December 2016 with no language restrictions. Search keywords included HIV, syphilis and diagnosis.

Review methods: We included studies that evaluated the operational characteristics of dual HIV/syphilis RDTs. Outcomes included diagnostic test accuracy, cost effectiveness, ease of use and interpretation and acceptability. All studies were assessed against quality criteria and assessed for risk of bias.

Results: Of 1914 identified papers, 18 were included for the meta-analysis of diagnostic accuracy for HIV and syphilis. All diagnostic accuracy evaluation studies showed a very high sensitivity and specificity for HIV and a lower, yet adequate, sensitivity and specificity for syphilis, with some variation among types of test. Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients, who cited time to result, cost and the requirement of a single finger prick as important characteristics of dual RDTs.

Conclusion: The results of this systematic review and meta-analysis can be used by policy-makers and national programme managers who are considering implementing dual RDTs for HIV and syphilis.

Trial registration number: PROSPERO 2016:CRD42016049168.

Keywords: HIV; diagnosis; syphilis; systematic reviews; testing.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the number of records initially identified and that were subsequently excluded or included in the meta-analysis on the performance and operational characteristics of dual point-of-care tests for HIV and syphilis. PRISMA, preferred reporting items for systematic reviews and meta-analysis.
Figure 2
Figure 2
Meta-analysis of the diagnostic accuracy of dual HIV/syphilis RDTs, stratified according to manufacturer. Forest plots are sown for the diagnostic accuracy of (A) HIV and (B) syphilis diagnosis. Summary ROC curves are shown for the diagnosis of (C) HIV and (D) syphilis. RDTs, rapid diagnostic tests; ROC, receiver operating characteristic.
Figure 3
Figure 3
Meta-analysis of the diagnostic accuracy of dual HIV/syphilis RDTs, stratified according to the setting in which the evaluation was conducted. Forest plots are shown for the diagnostic accuracy of (A) HIV and (B) syphilis diagnosis. Summary ROC curves are shown for (C) HIV and (D) syphilis diagnosis. RDTs, rapid diagnostic tests; ROC, receiver operating characteristic.
Figure 4
Figure 4
Meta-analysis of the diagnostic accuracy of dual HIV/syphilis RDTs, stratified according to the specimen type (serum or whole blood) used in the evaluation studies. Forest plots are shown for the diagnostic accuracy of (A) HIV and (B) syphilis diagnosis. Summary ROC curves are shown for (C) HIV and (D) syphilis diagnosis. RDTs, rapid diagnostic tests; ROC, receiver operating characteristic.
Figure 5
Figure 5
Meta-analysis of the diagnostic accuracy of dual HIV/syphilis RDTs, stratified according to the specimen type (archived, ie, frozen specimens or fresh specimens). Forest plots are shown for the diagnostic accuracy of (A) HIV and (B) syphilis diagnosis. Summary ROC curves are shown for (C) HIV and (D) syphilis diagnosis. FN, false negative; FP, false positive; RDTs, rapid diagnostic tests; ROC, receiver operating characteristic; TN, true negative; TP, true positive.
See this image and copyright information in PMC

References

    1. Wijesooriya NS, Rochat RW, Kamb ML, et al. Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study. Lancet Glob Health 2016;4:e525–3. - PMC - PubMed
    1. UNAIDS. Global AIDS Update - 2016. 2016. www.unaids.org/en/resources/documents/2016/Global-AIDS-update-2016 (accessed 13 Oct 2016).
    1. Mabey D, Peeling RW. Syphilis, still a major cause of infant mortality. Lancet Infect Dis 2011;11:654–5. - PubMed
    1. Teasdale CA, Marais BJ, Abrams EJ. HIV: prevention of mother-to-child transmission. BMJ Clin Evid 2011;2011. - PMC - PubMed
    1. WHO. Global guidance on Criteria and Processes for Validation: elimination of Mother-to-Child Transmission of HIV and Syphilis. 2014. http://apps.who.int/iris/bitstream/10665/112858/1/9789241505888_eng.pdf (accessed 21 Dec 2016).

MeSH terms

LinkOut - more resources