Misdiagnosed HIV infection in pregnant women initiating universal ART in South Africa

Nei-yuan Hsiao, Allison Zerbe, Tamsin K. Phillips, Landon Myer, Elaine J. Abrams

Rapid diagnostic tests (RDTs) are the primary diagnostic tools for HIV used in resource-constrained settings. Without a proper confirmation algorithm, there is concern that false-positive (FP) RDTs could result in misdiagnosis of HIV infection and inappropriate antiretroviral treatment (ART) initiation, but programmatic data on FP are few.

We examined the accuracy of RDT diagnosis among HIV-infected pregnant women attending public sector antenatal services in Cape Town, South Africa. We describe the proportion of women found to have started on ART erroneously due to FP RDT results based on pre-ART viral load (VL) testing and enzyme-linked immunosorbent assay (ELISA).

Compared to the cost of confirming the RDT-based diagnoses, the cost of HIV misdiagnosis is high. While testing programmes based on RDT should strive for constant quality improvement, where resources permit, laboratory confirmation algorithms can play an important role in strengthening the quality of HIV diagnosis in the era of universal ART.

August 31, 2017
Year of publication
Resource types
Journal and research articles
rapid diagnostic tests (RDTs), pregnant women, universal antiretroviral treatment (ART), antiretroviral therapy (ART), ART, treatment, HIV misdiagnosis, misdiagnosis, diagnostic tools, false positive, ART initiation, testing accuracy, testing errors, South Africa, viral load testing, enzyme-linked immunosorbent assay (ELISA), diagnosis