title: Performance of six diagnostic tests to screen for Chagas disease in blood banks andprevalence of Trypanosoma cruzi infection among donors with inconclusive serologyscreening based on the analysis of epidemiological variables.
abstract: OBJECTIVE
  The frequent occurrence of inconclusive serology in blood banks and the absence of a gold standard test for Chagas'disease led us to examine the efficacy of the blood culture test and five commercial tests (ELISA, IIF, HAI, c-ELISA, rec-ELISA) used in screening blood donors for Chagas disease, as well as to investigate the prevalence of Trypanosoma cruzi infection among donors with inconclusive serology screening in respect to some epidemiological variables.
  
  
  METHODS
  To obtain estimates of interest we considered a Bayesian latent class model with inclusion of covariates from the logit link.
  
  
  RESULTS
  A better performance was observed with some categories of epidemiological variables. In addition, all pairs of tests (excluding the blood culture test) presented as good alternatives for both screening (sensitivity > 99.96% in parallel testing) and for confirmation (specificity > 99.93% in serial testing) of Chagas disease. The prevalence of 13.30% observed in the stratum of donors with inconclusive serology, means that probably most of these are non-reactive serology. In addition, depending on the level of specific epidemiological variables, the absence of infection can be predicted with a probability of 100% in this group from the pairs of tests using parallel testing.
  
  
  CONCLUSIONS
  The epidemiological variables can lead to improved test results and thus assist in the clarification of inconclusive serology screening results. Moreover, all combinations of pairs using the five commercial tests are good alternatives to confirm results.
authors.affiliation: Universidade Federal do Triângulo Mineiro - UFTM, Uberaba, MG, Brazil.
authors.forename: Gilberto de Araujo
authors.initials: Gde A
authors.lastname: Pereira
authors.forename: Francisco
authors.initials: F
authors.lastname: Louzada-Neto
authors.forename: Valdirene de Fátima
authors.initials: Vde F
authors.lastname: Barbosa
authors.forename: Márcia Maria
authors.initials: MM
authors.lastname: Ferreira-Silva
authors.forename: Helio
authors.initials: H
authors.lastname: de Moraes-Souza