Performance characteristics of an HIV risk screening tool in Uganda

Introduction: Improving HIV testing efficiency has been documented to save financial and material resources for health.  In October 2019, the Ministry of HealthH Uganda deployed an HIV risk screening tool for use in 24 health facilities targeting clients aged 15 years and above in both outpatient and Voluntary Counselling and Testing departments. Methods: We conducted a retrospective secondary data analysis of routinely collected HIV risk screening program data in Uganda, collected from October to November 2019, to determine the performance characteristics of the adolescent and adult HIV risk screening tool in public health facility settings. Statistical measures for the risk screening tool performance included sensitivity, specificity, positive and negative predictive values, and cost analysis.  Results: A total of 19,854 clients were screened for HIV testing eligibility; we excluded 150 records with incomplete testing information. 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 found to be 90.7% (95% CI: 88.4%, 92.7%) and 75.8%, (75.2–76.4) 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% (4,825/19,704) reduction in testing volume, 9.3% (68/732) of PLHIV would have been missed as they were misclassified as not eligible for testing. The cost per PLHIV identified fell by 3% from $69 without screening to $66.9 with the implementation of the screening tool.  Conclusions: The use of an HIV risk screening tool in OPD settings in Uganda demonstrated improved HIV testing efficiency by reducing testing volumes but resulted in screening out of nine of every 100 people living with HIV. The team recommends the use of scientifically validated HIV risk screening tools, and a need to explore the use of HIV self-testing as a test for triage. We conducted a secondary data analysis, of DHIS2 data from 24 health facilities in Uganda, on clients who were screened for HIV testing eligibility using a risk screening tool, and tested for HIV. All clients that were screened were tested irrespective of their screening outcome. The data had been collected and de-identified before being reported in the DHIS2.  We received approval from Ministry of Health Uganda to access the DHIS2 data from district Biostatiscians, and we cleaned the dataset by removing entries with missing values, suing the excel sheet Excel, Stata SPSS Epi info