A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis

• Published in: Sexually transmitted infections Vol. 93; no. S4; pp. S3 - S15
• Main Authors: Gliddon, Harriet D, Peeling, Rosanna W, Kamb, Mary L, Toskin, Igor, Wi, Teodora E, Taylor, Melanie M
• Format: Journal Article
• Language: English
• Published: England 01.12.2017
• Subjects: Female; HIV Infections - diagnosis; HIV Infections - transmission; Humans; Infectious Disease Transmission, Vertical - prevention & control; Point-of-Care Systems; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - prevention & control; Pregnancy Outcome; Prenatal Diagnosis; Sensitivity and Specificity; Syphilis - diagnosis; Syphilis - transmission; Syphilis, Congenital - prevention & control; Syphilis, Congenital - transmission; diagnosis; syphilis; systematic reviews; HIV; testing
• DOI: 10.1136/sextrans-2016-053069
• ISSN: 1368-4973; 1472-3263

BackgroundMother-to-child transmission (MTCT) of syphilis and HIV continue to be important yet preventable causes of perinatal and infant morbidity and mortality.ObjectivesTo systematically review, critically appraise and perform a meta-analysis to evaluate the operational characteristics of dual rapid diagnostic tests (RDTs) for HIV/syphilis and evaluate whether they are cost effective, acceptable and easy to use.DesignSystematic review and meta-analysis.Data sourcesWe searched seven electronic bibliographic databases from 2012 to December 2016 with no language restrictions. Search keywords included HIV, syphilis and diagnosis.Review methodsWe included studies that evaluated the operational characteristics of dual HIV/syphilis RDTs. Outcomes included diagnostic test accuracy, cost effectiveness, ease of use and interpretation and acceptability. All studies were assessed against quality criteria and assessed for risk of bias.ResultsOf 1914 identified papers, 18 were included for the meta-analysis of diagnostic accuracy for HIV and syphilis. All diagnostic accuracy evaluation studies showed a very high sensitivity and specificity for HIV and a lower, yet adequate, sensitivity and specificity for syphilis, with some variation among types of test. Dual screening for HIV and syphilis was more cost effective than single rapid tests for HIV and syphilis and prevented more adverse pregnancy outcomes. Qualitative data suggested dual RDTs were highly acceptable to clients, who cited time to result, cost and the requirement of a single finger prick as important characteristics of dual RDTs.ConclusionThe results of this systematic review and meta-analysis can be used by policy-makers and national programme managers who are considering implementing dual RDTs for HIV and syphilis.Trial registration numberPROSPERO 2016:CRD42016049168.