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CDC’s Center for Global Health
Self-Reported HIV-Positive but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment (PHIA) Surveys—11 Sub-Saharan African Countries, 2015–2018
Naeemah Logan, M.D.Epidemic Intelligence Service OfficerCenters for Disease Control and Prevention, Atlanta Georgia, USADivision of Global HIV and TB
INTEREST Conference
May 16th, 2019
Poster #18
BACKGROUND2
❑ Few studies have evaluated frequency of HIV false positive diagnoses using population-based survey data
❑ We analyzed data from cross-sectional, nationally representative Population-Based HIV Impact Assessment (PHIA) surveys
Study Justification
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Study Objective
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❑ Use combined data from 11 PHIA surveys to characterize individuals who self-reported as HIV+ but tested HIV-
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PHIA Surveys in 11 Countries, 2015 – 2018
❑ Nationally representative, household-based surveys
❑ PHIA Countries
-Cameroon-Cote d’Ivoire-Ethiopia-Lesotho
-Malawi-Namibia-Eswatini-Tanzania
-Uganda-Zambia-Zimbabwe
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Eswatini
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HIV Testing at the Household
Household
Satellite Lab
Central Lab
Testing of Participants who Self-Reported as HIV+
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Self-reported HIV+
Tested HIV- by RDT national algorithm
Household
Satellite Lab
Central Lab
Testing of Participants who Self-Reported as HIV+
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Tested HIV- by RDT algorithm
Repeat RDT using national algorithm
Household
Satellite Lab
Central Lab
Testing with BioRadGeenius HIV-1/HIV-2
Self-reported HIV+
Testing of Participants who Self-Reported as HIV+
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Tested HIV- by RDT national algorithm
DNA PCR testing if negative
Household
Satellite Lab
Central LabSelf-reported HIV+
Repeat RDT using national algorithm
Testing with BioRadGeenius HIV-1/HIV-2
Testing of Participants who Self-Reported as HIV+
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Characteristic n Weighted %
Self-reported as HIV+
Lab confirmed HIV-
Lab confirmed HIV+
16,630
198
16,432
100
1.4
98.6
Self-reported HIV Status and Final HIV Test Results, 11 PHIA Countries (N=221,941)
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Characteristic n Weighted %
ART Status*
Lab confirmed HIV-
Lab confirmed HIV+
49
14,457
0.6
99.4
Self-reported Antiretroviral Treatment Status and Final HIV Test Results, 11 PHIA Countries (N=16,630)
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*Self-report
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❑ 73,000 potentially misclassified as HIV+
❑ 29,000 inappropriately started ART
Extrapolation to Overall HIV+ Burden across 11 PHIA Countries among Adults Aged ≥ 15 years
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❑ Quality assurance in testing
❑ Clear communication about HIV test results
❑ Retesting prior to ART initiation
Recommendations
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CDC’s Center for Global Health
Self-Reported HIV-Positive but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment (PHIA) Surveys—11 Sub-Saharan African Countries, 2015–2018
Naeemah Logan1, Yen Pottinger2, Hetal Patel1, Suzue Saito2, Kiwon Lee2, Sasi Jonnalagadda1, Peter H. Kilmarx3, Italia Rolle1, Andrew Voetsch1, Bharat Parekh1
1 Centers for Disease Control and Prevention (CDC), 2 ICAP-Columbia, 3 National Institutes of Health (NIH)
Italia Rolle1, Andrew Voetsch1, Bharat Parekh1
Poster Session: #18 / Today / 10:30AM - 11:00AM14
Acknowledgements
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EIS Supervisors:
Italia Rolle
Drew Voetsch
Co-Authors:
Yen Pottinger
Hetal Patel
Suzue Saito
Kiwon Lee
Sasi Jonnalagadda
Peter H. Kilmarx
Bharat Parekh
CDC-Atlanta:
Solape Ajiboye
Arnesler Coleman
Sehin Birhanu
Stephane Bodika
Stephen McCracken
Carin Molchan
Carole Moore
Christopher Murrill
Katina Pappas-Deluca
Jacqueline Rurangirwa
Vedapuri Shanmugam
Katrina Sleeman
Paul Stupp
Daniel Williams
Floris Wray-Gordon
Daniel Yavo
Ernest Yufenyuy
Nolana Woolfork
Megan Bronson
Kristin Brown
Janet Burnet
Melissa Cates
Gregory Chang
Reena Doshi
Mervi Detorrio
Trudy Dobbs
Linda Fleming
Avi Hakim
Wolfgang Hladik
Keisha Jackson
Steven Kinchen
Nikihil Kothegal
Bill Levine
Kathryn Lupoli
Additional thanks to:CDC International Laboratory Branch (ILB)CDC Division of Global HIV and TB (DGHT)PHIA staff and field teams
EISOs:Victor Eboh (EIS Class of 2017)John Rossow (EIS Class of 2018)