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

43

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)