Alert, but not alarmed - a comment on "Towards more accurate HIV testing in sub-Saharan Africa: a multi-site evaluation of HIV RDTs and risk factors for false positives (Kosack et al. 2017)".

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To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status.

INTRODUCTION: In accordance with global testing and treatment targets, many countries are seeking ways to reach the "90-90-90" goals, starting with diagnosing 90% of all people with HIV. Quality HIV testing services are needed to enable people with HIV to be diagnosed and linked to treatment as early as possible. It is essential that opportunities to reach people with undiagnosed HIV are not missed, diagnoses are correct and HIV-negative individuals are not inadvertently initiated on life-long treatment. We conducted this systematic review to assess the magnitude of misdiagnosis and to describe poor HIV testing practices using rapid diagnostic tests. METHODS: We systematically searched peer-reviewed articles, abstracts and grey literature published from 1 January 1990 to 19 April 2017. Studies were included if they used at least two rapid diagnostic tests and reported on HIV misdiagnosis, factors related to potential misdiagnosis or described quality issues and errors related to HIV testing. RESULTS: Sixty-four studies were included in this review. A small proportion of false positive (median 3.1%, interquartile range (IQR): 0.4-5.2%) and false negative (median: 0.4%, IQR: 0-3.9%) diagnoses were identified. Suboptimal testing strategies were the most common factor in studies reporting misdiagnoses, particularly false positive diagnoses due to using a "tiebreaker" test to resolve discrepant test results. A substantial proportion of false negative diagnoses were related to retesting among people on antiretroviral therapy. Conclusions HIV testing errors and poor practices, particularly those resulting in false positive or false negative diagnoses, do occur but are preventable. Efforts to accelerate HIV diagnosis and linkage to treatment should be complemented by efforts to improve the quality of HIV testing services and strengthen the quality management systems, particularly the use of validated testing algorithms and strategies, retesting people diagnosed with HIV before initiating treatment and providing clear messages to people with HIV on treatment on the risk of a "false negative" test result

Immigration and the politics of American sovereignty, 1890 to 1990. (Volumes I and II).

In the era of popular sovereignty, preserving the state has meant protecting the boundaries separating populations. Arguments offered in immigration debates in the United States from 1890 to 1990 demonstrate whether, and the extent to which, Americans believed immigrants to threaten sovereignty. Sovereignty was in fact invoked explicitly in every era of major policy change. Public arguments also focused attention on the nature of the threat that immigrants presented, and hence on the essence of American citizenship. In the late 19th and early 20th centuries, external threats were seen in racial terms, and race defined the difference between American citizens and others. By 1952, ideology overlaid, and partially deplaced, race as Americans' central identifying characteristic. Americans were no longer primarily white, but primarily democratic and capitalist. From the mid-1960s through 1990, liberal and human rights criteria were emphasized as American credibility in the cold war was seen to be at stake, though by the mid-1980s, economic competition had overtaken ideological concerns. When the central threat to the U.S. was seen in economic terms, economic values infused immigration preferences. Within this process, the demands of public-interest arguments rather than material interests best explain the policy outcome. For any position to succeed, it had to justify itself in terms of ideas about threat, equity, and the meaning of history. The result in each period were policies that established a new view of what ought to be inside and outside the borders dividing citizen from noncitizen. Alterative explanations of policy change such as those focusing on partisanship, unemployment, public opinion, or immigrant interest groups prove unsatisfactory. Structural theories of world politics can only offer partial clarification since countries have freed trade while they have extended regulatory control over admission to citizenship. If legislators and others understand themselves to be creating or maintaining sovereignty by restricting immigration, then sovereignty should be seen as a policy choice rather than as a structurally determined outcome.Ph.D.Political ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104388/1/9513480.pdfDescription of 9513480.pdf : Restricted to UM users only