Factors associated with accuracy of rapid HIV test performance in the Eastern Cape, South Africa.

Abstract

Background: Testing for HIV using rapid test devices assists in determining HIV status and ascertains if treatment is required. Rapid HIV quality assurance (QA) training is conducted to ensure accuracy of test results in non-laboratory settings.

Objectives: This study aimed to determine the factors associated with the accuracy of rapid HIV testing among primary healthcare (PHC) workers who received HIV testing QA training in the Eastern Cape, South Africa.

Method: A cross-sectional analytical study design was used to purposively recruit 167 PHC workers with prior training on HIV testing QA. Data were collected in 2022 using a self-administered questionnaire. STATA version 17.0 was used for data analysis.

Results: Tester accuracy measured by a proficiency testing (PT) score of greater than 80% was achieved among 64.7% of the testers. Comprehensive HIV QA training was significantly associated with a PT score of greater than 80% (P = 0.001). On multivariable analyses, a PT score of greater than 80% was less likely with rural facilities (adjusted odd ratios [aOR] = 0.56, 95% confidence interval [CI]: 0.36-0.92, P = 0.020), Grade 12 education (aOR = 0.40, 95% CI: 0.19-0.85, P = 0.017), mentorship (aOR = 0.55, 95% CI: 0.35-0.85, P = 0.008), and attitudes towards inaccurate HIV results (aOR = 0.13, 95% CI: 0.02-0.82, P = 0.03); while implementation of QA processes (aOR = 3.94, 95% CI: 1.22-12.74, P = 0.022) and elements of QA in the HIV Testing Services register (aOR = 4.93, 95% CI: 1.45-16.74, P = 0.011) were associated with a PT score of greater than 80%.

Conclusion: Exposure to comprehensive rapid HIV QA training were associated with higher tester accuracy. A framework for QA training is required for standardisation of training in the country.