Risk Screening Tools Could Potentially Miss HIV-Positive Individuals Who Seek Testing Services: A Secondary Program Data Analysis on the Performance Characteristics of an Adolescent and Adult HIV Risk Screening Tool in Uganda

Improving HIV testing efficiency saves financial and material resources for health. We conducted a secondary data analysis of routinely collected HIV risk-screening program data in Uganda, from October to November 2019, to determine the performance characteristics of the adolescent and adult HIV risk screening tools in public health facilities. A total of 19,854 clients had been screened for HIV testing eligibility and tested for HIV. The overall positivity rate (cluster-weighted prevalence of HIV) among those screened was 4.5% (95% CI: 4.1–4.8) versus 3.71% (95% CI: 3.06–4.50) among those not screened. The sensitivity and specificity of the risk screening tool were 91% (95% CI: 89–93) and 25% (24.2–26), respectively. With screening, the number needed to test to identify one PLHIV was reduced from 27 to 22. Although risk screening would have led to a 24.5% (4825/19,704) reduction in testing volume, 9.3% (68/732) of PLHIV would have been missed and be misclassified as not eligible for testing. The cost saving per PLHIV identified was minimally reduced by 3% from USD 69 without screening to USD 66.9 with screening. Since the treatment-adjusted prevalence of HIV is dropping globally, overzealous use of risk screening tools to determine who to test or not carries the potential of missing PLHIV due to their limited specificity. We recommend the use of scientifically validated HIV risk screening tools, and a need to explore the use of HIV self-testing as a test for tirage to minimize misclassification of people who seek HIV testing services

Preferential Secretion of Thymic Stromal Lymphopoietin (TSLP) by Terminally Differentiated Esophageal Epithelial Cells: Relevance to Eosinophilic Esophagitis (EoE) - Fig 2

<p><b>Calcium induces terminal differentiation of esophageal epithelial cells in-vitro A)</b> Cytokeratin 13 (CK13) and, <b>B)</b> involucrin (IVL), mRNA expression in response to high calcium (1.8mM CaCl₂) media at 0, 24, 48, and 72 hours. Results are representative of three separate experiments. *p<0.05, **p<0.01, ***p<0.001 and ****p<0.0001 as compared to undifferentiated (0 hr) cells. Immunoblot for <b>C)</b> involucrin in calcium differentiated EPC2-hTERT cells. <b>D</b>) IHC for TSLP on organotypic cultures of esophageal epithelium. SSE = Stratified squamous epithelium; B = Basal epithelium, Sub = subepithelium.</p

Patient demographics, and allergy test results.

<p>Patient demographics, and allergy test results.</p

Terminal differentiation of human esophageal epithelial cells enhances the inducible expression and secretion of TSLP protein <i>in vitro</i>.

<p>TSLP mRNA expression in poly (I:C)-stimulated undifferentiated (<b>A</b>) and differentiated (<b>B</b>) EPC2-hTERT cells. <b>C)</b> TSLP protein secretion (pg/mL) by poly (I:C)-stimulated undifferentiated and differentiated EPC2-hTERT cells. <b>D</b>) TLR3 mRNA expression in undifferentiated and differentiated EPC2-hTERT cells. Results are representative of three separate experiments. * p<0.05, p<0.01***p <0.001, p<0.0001 as compared to undifferentiated cells.</p

Food antigens induce esophageal epithelial TSLP expression.

<p>Quantification of TSLP mRNA expression following food antigen stimulation in undifferentiated <b>(A)</b> and differentiated <b>(B)</b> EPC2-hTERT cells. <b>C</b>) TSLP secretion (pg/mL) was quantified in undifferentiated and differentiated EPC2-hTERT cells. TSLP secretion in differentiated primary esophageal epithelial cells from non-EoE control subjects (N = 7) <b>(D)</b> and EoE subjects (N = 20) <b>(E)</b> following stimulation with food antigens. All cell lines were stimulated for 24 hours. (<b>F</b>) comparison of ova mediated TSLP expression in differentiated inactive and active EoE cells. The dashed lines represent the lower limit of sensitivity of the ELISA kit (8pg/mL). Bars represent the mean of each data set. * p<0.05, **p<0.01, ***p <0.001 as compared to unstimulated controls.</p

TSLP expression is restricted to the suprabasal differentiated compartment of the esophageal epithelium.

<p>Immunohistochemistry for TSLP (A,C,E) and cytokeratin 13 (CK13) (B,D,F) in esophageal pinch biopsies from representative non-EoE control subjects, subjects with inactive EoE (<15 eosinophils per hpf), and active EoE (≥15 eosinophils per hpf). 200X magnification. Larger images represent 100X magnification. The box represents the area chosen for 200X magnification in the smaller side panel. SSE = Stratified squamous epithelium; B = Basal epithelium.</p