title: Evaluation of SD Bioline HIV/syphilis Duo rapid test kits in Nepal.
abstract: BACKGROUND
  Accurate and prompt diagnosis of HIV and syphilis simultaneously has reinforcing effect on their control program because of their prevalent co-infection. Availability of a simple user-friendly two-pronged and affordable detection tools brings down the cost of health care. They are important in the antenatal clinics, with added opportunity for intervention and prevention of mother to child transmission. In cooperation with rapid test kit manufacturers, SD Bioline, NPHL and NCASC, an evaluation of commercially available HIV/syphilis Duo rapid test kit (SD Bioline) to assess its performance and operational characteristics was done in the present study.
  
  
  METHODS
  A prospective laboratory-based cross sectional study was conducted at a large Women's Hospital. Ten thousand pregnant women, visiting the Hospital for antenatal care or for delivery, were enrolled in study. Tests were performed by the SD Bioline HIV/Syphilis Duo kit as well as national algorithm for HIV and syphilis diagnosis which were considered gold standard. Sensitivity, Specificity, positive predictive value and negative predictive value along with kappa coefficient were calculated for the kit under evaluation.
  
  
  RESULTS
  The sensitivity, specificity, Negative predictive value and Positive predictive value of the kit for HIV diagnosis were 100 % (95 % CI 83.18-100 %, 99.96-100 %, 83.18-100 %, and 99.96-100 %, respectively). Kappa value was found to be 1.0. Out of total cases, results of 9985 (99.85 %) cases were concordant with National algorithm for syphilis diagnosis. Thirteen (0.13 %) cases were found false positive while two were false negative. The sensitivity of the kit for syphilis diagnosis was found to be 95.45 % (95 % CI 84.86-98.74 %) and specificity was 99.87 % (95 % CI; 99.78-99.92 %). Positive predictive value was 76.36 % (95 % CI; 63.65-85.63 %) and Negative predictive value was 99.89 % (95 % CI; 99.39-99.99 %). Kappa value was found to be 0.85.
  
  
  CONCLUSIONS
  The performance characteristics of SD Bioline HIV/Syphilis duo kit were found almost concordant with the kits being used for HIV and Syphilis diagnosis separately. Its implementation in antenatal clinics/VCTs could be an added opportunity for simultaneous diagnosis of HIV and syphilis.
authors: National Public Health Laboratory, Teku, Kathmandu, Nepal. geeta.nphl@gmail.com.
authors: Geeta
authors: G
authors: Shakya
authors: National Centre for AIDS and STD Control, Teku, Kathmandu, Nepal.
authors: Dipendra Raman
authors: DR
authors: Singh
authors: National Centre for AIDS and STD Control, Teku, Kathmandu, Nepal.
authors: Hemanta Chandra
authors: HC
authors: Ojha
authors: National Public Health Laboratory, Teku, Kathmandu, Nepal.
authors: Chet Raj
authors: CR
authors: Ojha
authors: National Public Health Laboratory, Teku, Kathmandu, Nepal.
authors: Shravan Kumar
authors: SK
authors: Mishra
authors: Paropakar Maternity Hospital, Kathmandu, Nepal.
authors: Karishma
authors: K
authors: Malla
authors: Paropakar Maternity Hospital, Kathmandu, Nepal.
authors: Puspa
authors: P
authors: Chaudhary
authors: Family Health Division, Teku, Kathmandu, Nepal.
authors: Kiran
authors: K
authors: Regmi
mesh_terms: D060085:Coinfection / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D009390:Nepal; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis*
chemical_list: D011933:Reagent Kits, Diagnostic
keywords: Duo test; Kappa coefficient; Sensitivity; Specificity