Confirmatory HIV testing may substantially reduce the number of false diagnoses. Many infants in South Africa have been falsely diagnosed as HIV-infected and have been given unneeded treatments. This is the finding of a recent research at the University of Cape Town, South Africa.
Confirmatory testing is recommended by the World Health Organization and South African guidelines, but in many settings, uptake is low.
The specificity of nucleic acid amplification tests (NAATs) for early infant HIV diagnosis (EID) is less than 100 percent, meaning some infants are incorrectly diagnosed with HIV. Using an existing computer simulation model of pediatric HIV, the authors of the new study examined the impact of a second NAAT in infants to confirm a first positive result. They assumed a NAAT cost of $25, specificity of 99.6%, and sensitivity of 100%.
"We find that use of a second NAAT for confirmatory testing in EID programmes will substantially reduce the proportion of infants incorrectly diagnosed as HIV-infected and initiated on ART in settings with low infant HIV transmission rates like South Africa" says Ms. Dunning. "While projected cost differences are small, confirmatory testing is likely to be cost-saving under a wide range of scenarios in South Africa," notes Dr. Andrea Ciaranello of Massachusetts General Hospital and Harvard Medical School, senior author on the study. "Concerns about the cost of the second test itself should not be the reason to avoid this important intervention."