The evolving HIV epidemic and its impact on the HIV testing algorithm: Is it time to change the HIV testing algorithm in South Africa?

• Published in: Journal of clinical virology 2021-11, Vol.144, p.104990-104990, Article 104990
• Main Authors: Mashishi, Bonolo Rankotsane, Makatini, Zinhle, Adu-Gyamfi, Clement Gascua
• Format: Article
• Language: English
• Subjects: 2-Step test algorithm; 3-Step test algorithm; Algorithms; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Testing; HIV testing strategy; Humans; South Africa - epidemiology; Testing algorithm
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2021.104990

•The evolving epidemic of Human Immunodeficiency Virus type 1 in Sub-Saharan Africa and South Africa.•The impact of the epidemic on diagnostic algorithms.•2019 World Health Organisation's HIV testing guidelines.•Considerations for implementing the new HIV algorithm in South Africa. HIV-1/2 testing is the first step in ensuring HIV-infected individuals are diagnosed and appropriately managed. The impact of suboptimal HIV-1/2 testing algorithms significantly contributes to the increased rates of misdiagnosis of HIV infection. Recently, the World Health Organization (WHO) recommended that high burden countries revise their testing algorithm from a 2 to 3-test testing strategy in the context of an evolving HIV epidemic. Implementation of a new HIV-testing algorithm must be tailor-made within a national framework and must be balanced out with operational feasibility, patient outcomes, and cost-effectiveness. In this review, we provide an overview of the current state of the HIV epidemic and its impact on HIV testing, further we highlight areas of concern in changing from a 2-step to a 3-step test algorithm in the context of South Africa's HIV epidemic and public health program.