Low and Decreasing Prevalence and Rate of False Positive HIV Diagnosis - Chókwè District, Mozambique, 2014-2017

Abstract

In 2017, rapid human immunodeficiency virus (HIV) testing services enabled the HIV diagnosis and treatment of approximately 15.3 million persons with HIV infection in sub-Saharan Africa with life-saving antiretroviral therapy (ART) (1). Although suboptimal testing practices and misdiagnoses have been reported in sub-Saharan Africa and elsewhere, trends in population burden and rate of false positive HIV diagnosis (false diagnosis) have not been reported (2,3). Understanding the population prevalence and trends of false diagnosis is fundamental for guiding rapid HIV testing policies and practices. To help address this need, CDC analyzed data from 57,655 residents aged 15-59 years in the Chókwè Health and Demographic Surveillance System (CHDSS) in Mozambique to evaluate trends in the rate (the percentage of false diagnoses among retested persons reporting a prior HIV diagnosis) and population prevalence of false diagnosis. From 2014 to 2017, the observed rate of false diagnosis in CHDSS decreased from 0.66% to 0.00% (p<0.001), and the estimated population prevalence of false diagnosis decreased from 0.08% to 0.01% (p = 0.0016). Although the prevalence and rate of false diagnosis are low and have decreased significantly in CHDSS, observed false diagnoses underscore the importance of routine HIV retesting before ART initiation and implementation of comprehensive rapid HIV test quality management systems (2,4,5).

FIGURE

National rapid and CDC confirmatory HIV testing algorithms for survey participants aged 15–59 years who reported having received a prior HIV diagnosis — Chókwè Health Demographic Surveillance System (CHDSS), Chókwè, Mozambique, 2014–2017 Abbreviations: DBS = dried blood spot; EIA = enzyme immunoassay; gp41 = glycoprotein 41; HIV = human immunodeficiency virus; PCR = polymerase chain reaction. * The Mozambique national rapid test algorithm refers to the use of Determine followed by Uni-Gold in accordance with national HIV testing guidelines. Prior HIV diagnosis is defined as reporting during the CHDSS survey of 1) ever having tested HIV-positive, 2) testing HIV-positive at the last test, or 3) currently or ever receiving HIV care.