title: Performance and cost-effectiveness of a dual rapid assay system for screening and confirmation of human immunodeficiency virus type 1 seropositivity.
abstract: Recent studies have shown that rapid, instrument-free assays for the detection of antibody to human immunodeficiency virus (HIV) can be as sensitive and specific as enzyme-linked immunosorbent assay (ELISA) for screening of donated blood in developing countries. Currently, however, specimens which test positive on a screening assay must still be confirmed by Western blot (immunoblot), a method which is not feasible in most developing-country laboratories. We examined whether a testing hierarchy which utilizes neither conventional ELISA nor Western blot can be reliably used for screening and confirmation of HIV infection in a high-risk population. In a retrospective analysis of 3,878 specimens which were screened for antibody to HIV in Kinshasa, Zaire, we observed that a testing hierarchy consisting of duplicate HIVCHEK screening assays followed by duplicate Serodia-HIV confirmatory assays resulted in correct confirmation of all ELISA- and Western blot-positive specimens. We conclude that such a testing hierarchy can produce highly accurate results for identification of positive specimens in routine HIV testing and provides a practical alternative to conventional methods of HIV screening and confirmation.
authors.affiliation: Program for Appropriate Technology in Health, Seattle, Washington 98109.
authors.forename: F A
authors.initials: FA
authors.lastname: Spielberg
authors.forename: C M
authors.initials: CM
authors.lastname: Kabeya
authors.forename: T C
authors.initials: TC
authors.lastname: Quinn
authors.forename: R W
authors.initials: RW
authors.lastname: Ryder
authors.forename: N K
authors.initials: NK
authors.lastname: Kifuani
authors.forename: J
authors.initials: J
authors.lastname: Harris
authors.forename: T R
authors.initials: TR
authors.lastname: Bender
authors.forename: W L
authors.initials: WL
authors.lastname: Heyward
authors.forename: M R
authors.initials: MR
authors.lastname: Tam
authors.forename: K
authors.initials: K
authors.lastname: Auditore-Hargreaves
mesh_terms: D001782:Blood Donors; D015153:Blotting, Western; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004797:Enzyme-Linked Immunosorbent Assay; D005069:Evaluation Studies as Topic; D015483:HIV Antibodies / Q000032:analysis; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007118:Immunoassay / Q000191:economics / Q000379:methods*; D008403:Mass Screening
chemical_list: D015483:HIV Antibodies