Original Research

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Tivani P. Mashamba-Thompson, Pravi Moodley, Benn Sartorius, Paul K. Drain
Southern African Journal of HIV Medicine | Vol 19, No 1 | a771 | DOI: https://doi.org/10.4102/sajhivmed.v19i1.771 | © 2018 Tivani P. Mashamba-Thompson, Pravi Moodley, Benn Sartorius, Paul K. Drain | This work is licensed under CC Attribution 4.0
Submitted: 04 June 2017 | Published: 23 May 2018

About the author(s)

Tivani P. Mashamba-Thompson, Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
Pravi Moodley, Department of Virology, University of KwaZulu-Natal, South Africa and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, South Africa
Benn Sartorius, Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
Paul K. Drain, International Clinical Research Center, Department of Global Health, University of Washington, United States; Department of Medicine, University of Washington; Department of Epidemiology, University of Washington, United States and Department of Surgery, Massachusetts General Hospital, Harvard Medical School,, United States

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Introduction: South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN).

Method: We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test.

Results: Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% – 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% – 100%) and 99% (CI: 95% – 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% – 100%) and 95% (CI: 88% – 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN.

Conclusion: Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings.


HIV/AIDS; rapid diagnostic test; pregnant women; antenatal clinic; diagnostic accuracy South Africa


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