Optimizing the delivery of HIV counseling and testing services: the Uganda experience using rapid HIV antibody test algorithms

Abstract

The AIDS Information Center (AIC) was established in Kampala, Uganda in 1990 in response to increasing interest by members of the general public who wished to know their HIV serostatus. By 1996, >300,000 clients had been seen. HIV serologic testing was performed at a central laboratory and results reported back to AIC after 2 weeks. Approximately 25% of clients failed to learn their HIV serostatus as a result of failure to return or late arrival of results. To address these issues, AIC carried out an evaluation of 3 rapid HIV assays, Sero-Strip, SeroCard, and Capillus, against a standard criterion to identify a testing algorithm that could be used as an on-site confirmatory testing strategy. The study was carried out over a period of 5 working days and 325 clients were seen. An algorithm was identified, which gave no indeterminate results with unambiguously positive or negative specimens, which was 100% sensitive and specific, and which could be integrated with minimal disruption into existing counseling procedures. All clients left AIC knowing their HIV serostatus and having spent <2 hours at the Center. The results of this evaluation demonstrate that "same-day" results can be provided in counseling and testing settings without compromising the quality of counseling or the accuracy of HIV testing.

PIP: An evaluation conducted at the AIDS Information Center in Kampala, Uganda, demonstrated that same-day HIV results can be provided in counseling and testing centers without compromising service quality. The Center was established in 1990 in response to widespread public interest in HIV serodiagnosis. By 1996, more than 300,000 clients had been tested. However, 25% of these clients never received their result because of failure to report back to the Center after 2 weeks (the time required for results to be returned from an off-site laboratory) or late arrival of results. To address this problem, the Center evaluated three rapid HIV assays (Sero-Strip, SeroCard, and Capillus) against a standard criterion to identify a testing algorithm that could be used as an on-site confirmatory testing strategy. 325 clients were enrolled in the 5-day evaluation. Individually, all three rapid tests performed well when compared with the standard criterion result. The resulting algorithm (a combination of Capillus as the screening assay and SeroCard as a supplementary assay for initially positive specimens and Multispot as a tie-breaker assay) gave no indeterminate results, was 100% sensitive and specific, and could be integrated easily into existing counseling protocols. The entire process (registration, test decision counseling, phlebotomy, laboratory testing, prevention counseling, and post-test counseling) took an average of 2 hours to complete.