ACCURACY AND COSTS OF RAPID HUMAN-IMMUNODEFICIENCY-VIRUS TESTING TECHNOLOGIES IN RURAL HOSPITALS IN ZAMBIA

Objective: To evaluate the accuracy and costs of newer rapid human imm unodeficiency virus (HIV) antibody tests in primary health care settin gs in rural Zambia, Methods: Three rural hospitals participated in thi s study. During a baseline assessment period, HIV testing practices we re recorded on 250 consecutive clients at each hospital. Baseline eval uation was compared with 250 subsequent consecutive clients tested usi ng a testing algorithm consisting of an initial screening HIV Dipstick test (McDonald Scientific [PVT] Limited, Harare, Zimbabwe) followed b y confirmatory testing of all reactive specimens using the HIV Capillu s test (Cambridge Diagnostics, Galway, Ireland), in conformity with Wo rld Health Organization HIV testing recommendations. Quality control w as performed at a national university teaching hospital laboratory. Re sults: A total of 1,500 clients was entered, with an HIV seropositivit y rate of 53.2%. Most HIV testing was performed on patients with signs and symptoms suggestive of HIV infection. Same-day results were provi ded for only 16%. The HIV Dipstick testing algorithm sensitivity was 9 6.9%, and specificity was 98.0%. Counselor dissatisfaction was greater with the Dipstick algorithm as a result of 5.3% discordant results. U se of the HIV Dipstick testing algorithm cost between US$3.00 and US$3 .80 per client tested. Conclusions: The accuracy of HIV testing in uns ophisticated rural laboratories in Zambia is acceptable. Although BTV Dipstick testing algorithm costs were relatively high for a developing country, this HIV testing procedure is currently the most economical method available in Zambia. Accurate, less costly HIV testing algorith ms are still needed.