title: High accuracy of home-based community rapid HIV testing in rural Malawi.
abstract: OBJECTIVE
  To assess the performance of rapid HIV antibody tests when used as part of a home-based community wide counseling and testing strategy in northern Malawi.
  
  
  METHODS
  A cross-sectional population survey of HIV infection, 2007 to 2008.
  
  
  METHODS
  Adults aged 15 years or older in a demographic surveillance area were counseled and then offered an HIV test at their home by government-certified counselors. Two initial rapid tests (Determine and Uni-Gold) were performed on all samples and a third, tie-breaker test (SD Bioline) used to resolve discordant results. All people who wanted to know were posttest-counseled and informed of their results with referral to local clinical services if found to be HIV-positive. Laboratory quality control comprised retesting all positive and every tenth negative venous blood sample collected.
  
  
  RESULTS
  A total of 10,819 adults provided venous blood samples for HIV testing, of whom 7.5% (813) were HIV-positive. The accuracy of the parallel testing strategy used was high with 99.6% sensitivity, 100.0% specificity, 99.9% positive predictive value, and 99.9% negative predictive value.
  
  
  CONCLUSIONS
  Face-to-face rapid testing by health personnel with minimum training at the client's home performs well when used on a wide scale in the community setting.
authors.affiliation: Karonga Prevention Study, Karonga District, Malawi.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Molesworth
authors.forename: Richard
authors.initials: R
authors.lastname: Ndhlovu
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Banda
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saul
authors.forename: Bagrey
authors.initials: B
authors.lastname: Ngwira
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Crampin
authors.forename: Neil
authors.initials: N
authors.lastname: French
mesh_terms: D015492:AIDS Serodiagnosis / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006699:Home Care Services; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D011159:Population Surveillance; D012424:Rural Population