Photographed Rapid HIV Test Results Pilot Novel Quality Assessment and Training Schemes

HIV rapid diagnostic tests (RDTs) are now used widely in non-laboratory settings by non-laboratory-trained operators. Quality assurance programmes are essential in ensuring the quality of HIV RDT outcomes. However, there is no cost-effective means of supplying the many operators of RDTs with suitable quality assurance schemes. Therefore, it was examined whether photograph-based RDT results could be used and correctly interpreted in the non-laboratory setting. Further it was investigated if a single training session improved the interpretation skills of RDT operators. The photographs were interpreted, a 10-minute tutorial given and then a second interpretation session was held. It was established that the results could be read with accuracy. The participants (n = 75) with a range of skills interpreted results (>80% concordance with reference results) from a panel of 10 samples (three negative and seven positive) using four RDTs. Differences in accuracy of interpretation before and after the tutorial were marked in some cases. Training was more effective for improving the accurate interpretation of more complex results, e.g. results with faint test lines or for multiple test lines, and especially for improving interpretation skills of inexperienced participants. It was demonstrated that interpretation of RDTs was improved using photographed results allied to a 10-minute training session. It is anticipated that this method could be used for training but also for quality assessment of RDT operators without access to conventional quality assurance or training schemes requiring wet samples

Interpretation accuracy of four rapid diagnostic test (RDT) kits by three groups of participants before and after training.

<p>The table is divided into four quadrants by the level of participants' experience (inexperienced/experienced) and the difficulty of the RDT results (obvious/difficult). p<0.05 from non-parametric Chi Square analysis is considered as significant difference. Grey block indicated the significant differences between before and after training. <b>Bolded numbers</b> indicated significant differences between difficult and obvious results before training. # indicated significant differences between difficult and obvious results after training. ∧ indicated significant differences between inexperienced and experienced participants for obvious results. + indicated significant differences between inexperienced and experienced participants for difficult results.</p

Possible results for the three-line SD Bioline HIV rapid diagnostic test (RDT) that presents indicator lines for control, HIV-2 and HIV-1.

<p>HIV-1/2 positive (A), HIV-1 positive results (B, F & G), HIV-2 positive (C), HIV negative (D) and Invalid (E) results. A-E were considered "obvious" because the manufacturers' instruction illustrated these types of result. F & G are both HIV-1 positive and considered "difficult" because the correct interpretation required comparison of intensities for the middle and bottom lines (F), or the ability to see and interpret a faint line (top line, G).</p

Overall improvement in the interpretation accuracy for the three groups of participants.

<p>Non-laboratory based personnel (n = 19), laboratory based and trained technical staff (n = 22) and a group of pathologists attending a national meeting (n = 34) interpreted photographed results of 10 samples in four rapid diagnostic tests (RDT, see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018294#s2" target="_blank">Methods</a> Section). Each participant read 10 results for each test then was given an ∼10 minute tutorial on how to read the tests accurately and each was supplied with manufacturers' instructions. Training improved interpretation accuracy for each participant group (non-parametric Chi-Square test, p<0.05 for all groups).</p