Epidemic Intelligence Service, CDC, Atlanta, GA.
Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA.
J Acquir Immune Defic Syndr. 2024 Apr 1;95(4):313-317. doi: 10.1097/QAI.0000000000003363.
HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018.
Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate.
Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection.
A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.
HIV 检测是获得抗逆转录病毒治疗（ART）的关键步骤，因为早期诊断可以促进更早开始 ART。本研究报告了在 2015 年至 2018 年期间，在 11 个国家进行的具有全国代表性的基于人群的 HIV 影响评估调查中，自我报告 HIV 阳性但随后 HIV 检测阴性的个体的汇总数据。
调查参与者年龄在 15 岁及以上，由经过培训的人员使用标准问卷进行访谈，以确定 HIV 检测史和自我报告的 HIV 状况。调查人员根据各自国家的 HIV 检测服务算法，对符合条件的参与者进行家庭 HIV 检测和咨询，使用快速诊断检测，并返回检测结果。对所有被确定为 HIV 阳性和自我报告阳性的参与者进行实验室确认 HIV 检测，无论其 HIV 检测结果如何，均进行 Geenius HIV-1/2 和 DNA 聚合酶链反应检测，如果 Geenius 检测结果为阴性或不确定，则进行此项检测。
在 16630 名自我报告 HIV 阳性的参与者中，有 16432 名（98.6%）通过后续的实验室检测被确认为 HIV 阳性，198 名（1.4%）为 HIV 阴性。与实验室确认感染的自我报告 HIV 阳性且 HIV 检测阳性的参与者相比，自我报告 HIV 阳性但 HIV 检测阴性的参与者年龄明显较小，接受 ART 的可能性较低，接受 CD4 检测的可能性较低。
一小部分自我报告 HIV 阳性的个体无法被确认为阳性，这可能是由于最初的误诊、故意错误的自我报告或对问卷的误解。随着普遍获得 ART 的机会不断扩大，在开始 ART 之前，确保 HIV 检测的质量和 HIV 诊断的确认变得越来越重要。
