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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