MINISTRY OF HEALTH
TANZANIA PROJECT ECHO®HIVLAB TELEECHO™ SESSION
HIV TESTING STRATEGIES AND ALGORITHMS
Module 5
1
Learning Objectives
At the end of this module, you will be able to:
• Define Strategies and Algorithm in HIV Rapid testing
• Explain Advantages of National HIV RT Strategy and Algorithms
• Explain how sensitivity and specificity relate to development of an
HIV RT Algorithm
• Explain the HIV RT Algorithm approved in Tanzania
• Identify HIV status following a particular Algorithm
2
Content Overview
• Testing Strategies and Algorithms
• Developing National Testing Algorithm
• Measuring performance of HIV RT
• Interpreting HIV status
3
Definition of terms
• Strategies – An approach used to meet a specific need,
such as:
– Diagnosis
– Surveillance
– Blood transfusion service
• Algorithms – The combination and sequence of specific
tests used in a given strategy
Note: The number of algorithms should be limited
4
Tanzania HIV Rapid Testing Strategy
• Serial testing
– Samples tested by a first test
– Result of first test determines whether additional testing is
required
5
Advantages of National HIV Rapid Testing
Strategy and Algorithms
• Facilitates;
– Country-Level Standardization
– Procurement and Supply Management
– Training
– Quality Assuarance
6
Evaluating Test Performance:
Basic Terms
• Sensitivity (Se) of a test is its capacity to correctly
identify people that are infected with HIV.
• Specificity (Sp) of a test is its capacity to correctly
identify people that are not infected with HIV.
7
How Sensitivity and Specificity relate with
HIV RT Algorithm
• Higher rates of sensitivity will produce positive results when
HIV is present.
• Lower rates of sensitivity will produce more false negative
results.
• Higher rates of specificity will produce negative results when
HIV is not present.
• Lower rates of specificity will produce more false positive
results.
8
Importance of Test Performance
Evaluation
• To determine the Sequence of Testing (Algorithm)
• To select test devices to be used in a particular strategy
9
Testing Algorithm Describes the
Sequence of Tests to be Performed
• An HIV Positive Status should be based upon the
outcome of 2 or more tests
• When two test results disagree (one is reactive, the other
non-reactive), the finding is called “Inconclusive”
Always
Always follow
follow the
the
sequence
sequence of of the
the tests
tests
in
in the
the algorithm
algorithm
10
Approved HIV Test Kits Used in Tanzania
• Test 1: Bioline HIV 1/2 3.0
• Test 2: Uni-GoldTM HIV
11
National HIV Rapid Testing Algorithm
(January 2019)
12
Exercise: Interpreting HIV Status Using
Testing Algorithm
–Work alone to determine HIV status
–3 Minutes
13
Possible HIV Test Outcomes:
Serial Algorithm
TEST 1 TEST 2 Final result
Non-reactive NA Negative Negative
Reactive Reactive Positive
Positive
Reactive Non-reactive Inconclusive
14
Knowledge Check/Summary
• What is Strategies and Algorithm as applied in HIV Rapid testing
• How is sensitivity and specificity relate to development of an HIV
RT Algorithm?
• What are the HIV rapid testing algorithm used in Tanzania?
• How do you determine HIV status following a particular
Algorithm?
15
Key Message
• It is mandatory for each HTS provider to follow National
approved HIV RT algorithm
• In Tanzania Serial testing algorithm is used during offering
HIV RT services
16
Acknowledgement
• Ministry of Health (MoH)
• World Health Organization (WHO)
• Centers for Disease Control and Prevention (CDC)
• Amref Health Africa Tanzania
• Health Links Initiative (HLI)
• Tanzania Health Promotion Support (THPS)
• Management Development for Health (MDH)
17
References
• National comprehensive guidelines on HIV testing services
January 2019
• National framework for Point of care testing certification First Edition
2017
• WHO handbook on “Improving the Quality of HIV-Related
Point-of-Care Testing: Ensuring the Reliability and Accuracy
of Test Results
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