With 88% of HIV-1-infected individuals living in areas of high prevalence of non-B subtypes and with expanded global access to antiretroviral treatment (ART), studying disease progression amongst non-B subtypes gains relevance. Optimized clinical management is a possibility with knowledge of non-B subtype profiles at baseline, which is currently not possible due to lack of subtype-specific point-of-care assays. In a systematic review, we synthesized global evidence on differential disease progression amongst non-B subtypes in ART-naive individuals. Due to lack of consistent effect measures, we avoided pooling data and inferred patterns with respect to disease progression outcomes (ie, AIDS, Death, CD4, viral load changes). Subtypes C and D were more aggressive, followed by G, AE, and AG, and A being the least aggressive of all HIV-1 subtypes. Evidence of greater rates of disease progression in globally prevalent C and D subtypes highlight the importance of expanding early HIV detection, and determining subtype profile at baseline with CD4 staging to optimize the quality of ART delivery and care in global settings.

There are 31 million adults living with HIV-1 non-B subtypes globally, and about 10 million are on antiretroviral therapy (ART). Global evidence to guide clinical practice on ART response in HIV-1 non-B subtypes remains limited. We systematically searched 11 databases for the period 1996 to 2013 for evidence. Outcomes documented included time to development of AIDS and/or death, resistance mutations, opportunistic infections, and changes in CD4 cell counts and viral load. A lack of consistent reporting of all clinical end points precluded a meta-analysis. In sum, genetic diversity that precipitated differences in disease progression in ART-naïve populations was minimized in ART-experienced populations, although variability in resistance mutations persisted across non-B subtypes. To improve the quality of patient care in global settings, recording HIV genotypes at baseline and at virologic failure with targeted non-B subtype-based point-of-care resistance assays and timely phasing out of resistance-inducing ART regimens is recommended.

in 2009, accounting for a sevenfold increase since 1999. Accurate treponemal and non-treponemal serological testing are critical to providing a correct diagnosis, but there are substantial variations in the quality of serological diagnostic tests and testing across different parts of China. Since 2003, the Guangdong Provincial STI Control Center in collaboration with the Bureau of Public Health has developed a program on STIs laboratory construction and quality assurance system. We report the proficiency of serological test of syphilis among the STIs laboratories in Guangdong Province in 2004e2009. Methods Proficiency panels consisting of five samples with syphilis positive and negative sera were prepared in the provincial laboratory and sent to STIs laboratories for non-treponemal and treponemal testing once a year. Participating laboratories were asked to report the type of test used and quantitative and qualitative results for each serum. Each quantitative result was compared to the geometric mean of all participants' results, and was considered correct if it was less than fourfold difference from the mean titre. Results The numbers of STIs laboratories in Guangdong which participated in the survey increased from 19 to 225 and a total of 13 203 sera were tested from 2004 to 2009. 98% laboratories used the "toluidine red unheated serum" (TRUST) as their non-treponemal test and all laboratories used the "Treponema pallidum particle agglutination assay" (TPPA) as their treponemal test. (113/2754) of the results were found to be false negative and 2.3% (34/1456) were found to be false positive. For qualitative treponemal results, 6.5% (96/1470) and 1.9% (17/889) of treponemal results were found to be false-negative and false-positive respectively. For quantitative results, it was worth noting that in some cases, four to seven-titre deviations were observed for the same sera. Conclusion This province-wide STIs laboratory construction and quality assurance system has helped to improve the accuracies of serological syphilis testing over time. But there is still room for improvement to facilitate improved control of syphilis in China. Background The Gonococcal Antimicrobial Susceptibility Surveillance Program in Latin America and the Caribbean (GASP-LAC) in the 1990s had significant impact in identifying trends in antimicrobial susceptibility in the region. To revitalise the GASP-LAC, a survey was undertaken to determine the level of surveillance activity and the methods used for the identification and antimicrobial susceptibility testing (AST) of Neisseria gonorrhoeae (Ng) isolates. Methods A structured questionnaire was distributed to potential participants to collect information regarding surveillance activities and methods used for identification and ASTof Ng in LAC countries. Information was also obtained from presentations at the Workshop of the GASP-LAC in November 2010 in Buenos Aires, Argentina. P1-S4.28 SURVEY OF METHODOLOGY USED FORResults 7 countries completed the questionnaire and four provided unstructu...

evaluations. Overall, studies were concordant on findings of high acceptability and feasibility of POC tests as well as the testing strategy used. Preference was not well demonstrated in studies. Impact was particularly well demonstrated in antenatal clinic attendees by a clustered RCT. Barriers and challenges ranged from biotechnological limitations of the tests to lack of political will. Heterogeneous methodologies employed across studies to conduct economic evaluations made it difficult to draw conclusive statements. Conclusions Results were generally in agreement across studies, yet unsystematic methods of collecting and recording outcomes made it difficult to statistically combine outcomes. Weaknesses in the reporting of IROs limit our ability to form comprehensive contextspecific policies. Further efforts in establishing a framework for conducting implementation research is required. Background Recently Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift from diagnostic accuracy to emphasis on patient-centred outcomes for making policy recommendations. While meta-analyses have evaluated diagnostic accuracy of POC HIV tests, a systematic appraisal of other implementation research outcomes, such as cost, is lacking. Within this context, we reviewed global evidence on cost outcomes of OraQuick Advance HIVd1/2 Antibody Test. Method We systematically searched six electronic databases for the period of January 1999 to January 2011. Cost outcomes with OraQuick tests were reviewed and data extracted. For economic evaluation we accepted both partial and full study designs. Outcomes were synthesised into a narrative review. Results We identified nine studies offering economic evaluations of oral and blood based OraQuick, of which six were full economic evaluations and remaining were partial evaluations. The full economic evaluations included five Cost Effectiveness Analysis (CEA) and one Cost Utility Analysis (CUA) design; one partial evaluation was a cost comparison study and two were cost analysis studies. All studies were in the USA except one, which was from Mexico. All studies performed sensitivity analyses to explore the impact of uncertainty in their model parameters and findings. Methodological approaches applied by the authors were not standardised and program cost varied by location, but overall there was uniformity in the study conclusions. The studies concluded that OraQuick was cost effective in low prevalence settings and resulted in low rates of false positives which have favourable economic implications. The tests were found to be cost saving to the medical system, and offer the advantage of convenience in administration when compared to current standards of care. Since it was recognised that pre-and post-test counselling cost and personnel costs accounted for most of the overall costs for these rapid tests, one approach that was proposed to reduce this cost was to limit the time spent on counselling or by using lower-paid personnel for counselli...

BackgroundThe World Health Organization estimates that in 2006, there were 12 million new cases of syphilis. In developing countries, there is a lack of proper screening due to limited laboratory services and long distances from clinics. In developed countries, there is limited access to care among hard-to-reach populations. In this context of disconnect with the health care system, point of care (POC) tests have proven to be an invaluable resource, yet their accuracy needs to be established in order to justify their use.MethodElectronic databases were searched from 1 January 1980 to 24 September 2010 for articles evaluating syphilis POC tests. Data were extracted and a second reviewer independently reviewed a subset of the articles. Subgroups were made according to the index test, the sample tested, and reference standard employed. Pooled sensitivity and specificity were calculated using Hierarchical Summary Receiver Operating Characteristic Curve. Adjustments were made to account for imperfect reference standards.Results30 (47%) from 64 full text articles assessed articles were included in the meta-analysis. The most common kits evaluated were Determine, Bioline, Syphicheck, and Visitect in whole blood and sera samples. Using a Treponema Pallidum (TP) specific reference standard, in sera, the Determine test was the most accurate with a pooled sensitivity of 98.43% (96.03, 99.94) and a specificity of 97.74% (96.38, 98.92). In whole blood, Bioline was the most accurate with a sensitivity of 87.70% (84.78, 90.58) and a specificity of 99.07% (98.50, 99.59). The sensitivity of Determine and Visitect were lower when using whole blood than when using serum. When we adjusted for imperfect reference standards, the pooled parameters of accuracy improved when compared to pooled accuracy under the assumption of a perfect reference standard.ConclusionsDetermine with high sensitivity and Bioline with high specificity appeared to perform the best of the tests studied. Higher accuracy in serum warrants the use of serum rather than whole blood wherever possible. Confirmation with non-TP specific reference standard are required to confirm whether the infection is active or treated.