Screening Adults for HIV Testing in the Outpatient Department: An Assessment of Tool Performance in Malawi

• Published in: AIDS and behavior 2022-02, Vol.26 (2), p.478-486
• Main Authors: Moucheraud, Corrina, Hoffman, Risa M., Balakasi, Kelvin, Wong, Vincent, Sanena, Maria, Gupta, Sundeep, Dovel, Kathryn
• Format: Article
• Language: English
• Subjects: Adult; Adults; Diagnostic tests; Health behavior; Health Psychology; Health services; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Testing; Human immunodeficiency virus; Humans; Infectious Diseases; Malawi - epidemiology; Mass Screening; Medical screening; Medical tests; Medicine; Medicine & Public Health; Original Paper; Outpatient care facilities; Outpatients; Public Health; Questions; Sensitivity; Sexual behavior; Sexual partners; Sexually transmitted diseases; STD; Tests
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-021-03404-8

Little is known about screening tools for adults in high HIV burden contexts. We use exit survey data collected at outpatient departments in Malawi (n = 1038) to estimate the sensitivity, specificity, negative and positive predictive values of screening tools that include questions about sexual behavior and use of health services. We compare a full tool (seven relevant questions) to a reduced tool (five questions, excluding sexual behavior measures) and to standard of care (two questions, never tested for HIV or tested > 12 months ago, or seeking care for suspected STI). Suspect STI and ≥ 3 sexual partners were associated with HIV positivity, but had weak sensitivity and specificity. The full tool (using the optimal cutoff score of ≥ 3) would achieve 55.6% sensitivity and 84.9% specificity for HIV positivity; the reduced tool (optimal cutoff score ≥ 2) would achieve 59.3% sensitivity and 68.5% specificity; and standard of care 77.8% sensitivity and 47.8% specificity. Screening tools for HIV testing in outpatient departments do not offer clear advantages over standard of care.