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Evaluation of HIV Rapid Diagnostic Devices. National STD Prevention Conference San Diego, CA 6 March 2002. Jennifer A. Malia, MS, MT WRAIR. Outline. Rationale for rapid HIV diagnostics Retrospective evaluation of rapid serum tests Multiple rapid test algorithm results Conclusions.

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Evaluation of hiv rapid diagnostic devices

Evaluation of HIV Rapid Diagnostic Devices

National STD Prevention Conference

San Diego, CA

6 March 2002

Jennifer A. Malia, MS, MT

WRAIR


Outline
Outline

  • Rationale for rapid HIV diagnostics

  • Retrospective evaluation of rapid serum tests

  • Multiple rapid test algorithm results

  • Conclusions


Acknowledgment
Acknowledgment

  • LTC Nelson Michael

  • CPT Kris Calero

  • CPT Hassan Zahwa

  • LTC Merlin Robb



National importance of rapid diagnostics
National importance of rapid diagnostics

  • Impact on high prevalent/low return rate settings:

    •  true negative,  true positive

    •  false positive?

  • Occupational post-exposure prophylaxis (PEP) decisions.

  • Perinatal antiretroviral drug Rx decisions.

MMWR 47:211-215 (1998)


Military importance of rapid diagnostics
Military importance of rapid diagnostics

  • All issues for civilian community

  • Blood supply emergency screening.

    • Somalia, Bosnia, Kenya/Tanzania embassy bombings, USS Cole

  • Combat casualties testing.


Wrair cdc collaboration on hiv rapid diagnostics approach
WRAIR/CDC collaboration on HIVrapid diagnostics: approach

  • CDC: Prospective testing in areas of high HIV prevalence (intended use).

  • WRAIR: Retrospective testing of pedigreed serum archive.

  • FDA: WRAIR retrospective testing as substitute for low risk HIV population testing (e.g., blood banks)?



Retrospective testing at wrair
Retrospective testing at WRAIR

  • Serum panels are archived by EIA reactivity

    • All new panels are re-tested by EIA/WB

  • WRAIR is blinded to clinical data

  • Test devices were generally tested on unique panels

    Retrospective testing is not “intended use”



Performance modifiers
Performance Modifiers

  • Determine testing in Rakai, Uganda.

  • Use of single gp41 ID domain peptide for OraQuick.


Rakai uganda determine

Total specimens tested = 321

Tests censored = 120

EIA+/no WB f/u = 118 (data censored)

EIA-/QNS for Determine =2 (data censored)

Tests evaluated = 201

True pos = 21

False neg = 0

False pos = 17

True neg = 163

Sensitivity= 100%

Specificity = 90.6%

PPV+ = 63.4% (14% PP)

PPV- = 100%

Rakai, Uganda (Determine)



Algorithm development1
Algorithm development

  • Several rapid tests look technically promising

  • Corporate sponsors are moving toward FDA approval

  • WRAIR moving to algorithm testing on pedigreed serum panels

    Retrospective testing is not “intended use”


Strawman
“Strawman”

  • Posit: Multiple rapid tests will yield equivalent performance compared with EIA/WB algorithms.

  • Sensitive screening & specific confirmatory test(s).

  • Algorithms will differ based on HIV prevalence, performance modifiers, and cost-benefit analysis.


Serial algorithm panel
Serial algorithm panel

  • N = 400 pedigreed sera (23 R, 377 NR)

  • Two different rapid tests screen

    • Concordant NR = NR, final

    • Concordant R & discordant pair third rapid test.

  • 100% accurate

  • Moving to N = 3,000


Conclusions
Conclusions

  • Manufacturers have a serious intent to pursue FDA licensure.

  • This corporate intent should be highly encouraged by public health agencies to allow the future development of HIV testing algorithms with FDA approved devices.

  • Combinations of rapid tests appear to produce HIV tests results similar to EIA + Western blot.


Conclusions cont
Conclusions, cont.

  • Programs that serve point of care populations in resource poor settings will benefit from FDA licensed rapid HIV test devices.

  • Test algorithms need to be developed for different populations based on performance and feasibility of execution.


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