Prevalence Self-Reporting HIV Positivity but HIV Test Negative Among Six Sub-Saharan African Militaries

Background:  HIV rapid diagnostic tests (RDTs) are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs to have excellent sensitivity and specificity. However, false-positive RDT results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results.

Methods: We conducted HIV serosurveys in six sub-Saharan military populations and recorded the frequency of personnel self-reporting HIV positivity but subsequently testing HIV negative during the serosurvey.

Results: Personnel self-reporting HIV positivity but subsequently testing HIV negative ranged from 3.3% to 40.0%, suggesting significant rates of prior false-positive HIV RDTs.

Conclusions: Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization’s HIV testing guidelines. Other measures to improve test specificity include retesting of individuals with indeterminate results and classifying individuals with weakly reactive bands as HIV negative. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results is needed to prevent the significant physical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.