Toward a More Perfect World

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Presentation transcript:

Toward a More Perfect World … or at Least Better HIV Testing Algorithms

1987: State of the Art Western blot ELISA

1987: State of the Art

2005: State of the Art

2005: Still the Gold Standard? Western blot ELISA

Objectives Differ Across Settings Blood banks Donor screening: ↑ Sensitivity Confirmatory testing: ↑ Predictive value Reference laboratory ↑ Efficiency ↓ Cost ↓ Ambiguity HIV-2: ↑ Sensitivity, ↑ Surveillance Point-of care: rapid test combinations ↑ Positive predictive value ↑ Receipt of confirmed results Just about everybody, everywhere: ↓ Indeterminates

Assessment of Alternative Options How do we measure improvements? Gold standard: 14K or 24K? Indeterminate results don’t fit into 2 X 2 tables We have “truth” on our side Longitudinal follow-up “Realized sensitivity” The importance of testing is not the test result but in getting individuals test results … into care … on treatment

Moving Forward From Here Ready, Fire, …………… AIM!