title: Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.
abstract: BACKGROUND
  Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh.
  
  
  METHODS
  Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing.
  
  
  RESULTS
  The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum.
  
  
  CONCLUSIONS
  Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.
authors.affiliation: aDepartment of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh bHIV Section, UNICEF New York Headquarters, New York City, New York, USA cHIV Section, UNICEF Bangladesh, Dhaka, Bangladesh.
authors.forename: Saif U
authors.initials: SU
authors.lastname: Munshi
authors.forename: Tajudeen O
authors.initials: TO
authors.lastname: Oyewale
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Begum
authors.forename: Ziya
authors.initials: Z
authors.lastname: Uddin
authors.forename: Shahina
authors.initials: S
authors.lastname: Tabassum
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001459:Bangladesh; D005240:Feasibility Studies; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007118:Immunoassay / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015483:HIV Antibodies