Abstract:

The World Health Organization recommends retesting of newly diagnosed HIV cases for verification of results prior to antiretroviral therapy (ART) initiation. This study aimed at ascertaining the HIV status of clients on lifelong ART. We tested 25% of ART clients in 6 care and treatment (C&T) sites and all HIV-positive women receiving ART in 22 prevention of mother-to-child HIV transmission (PMTCT) sites in Northwest and Southwest regions. Testing was proposed consecutively to clients in group education sessions during ART refill visit until the sample size was achieved. Individual counselling was provided to clients who opted to be retested. Testing was with Determine HIV-1/2 and First Response rapid tests and further testing was with DNA-PCR. Clients with negative test results were counseled to discontinue ART. Results were analyzed comparing misdiagnosis at ART and PMTCT sites. A total of 4526 ART clients were retested for HIV; 3914(86.5%) from ART and 612(13.5%) from PMTCT sites. Female participants dominated (79%) and the median age was 39 years. Higher proportions of clients retested at PMTCT sites were negative with both tests (0.8% vs 0.1%) and had discordant results (1.1% vs 0.4%) than at ART sites. All 32 clients with negative or discordant results were tested with DNA-PCR and 22(0.5%) were negative; 11(0.3%) in ART and 11(1.8%) in PMTCT sites. HIV positive status was confirmed for 99.5% of clients retested, with a lower rate at PMTCT (98.2%) than C&T (99.7%) sites; meaning misdiagnosis and inappropriate ART treatment was more likely at PMTCT. Adherence to recommendation for HIV retesting for verification will reduce inappropriate treatment.

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