Communicating Indeterminate HIV Western Blot Test Results to Clients: An Observational Study of Three Community Testing Sites

Abstract

This study examined HIV test counselors' beliefs and practices regarding communicating indeterminate HIV test results to clients. There are many reasons for an indeterminate HIV antibody/ Western blot assay including early HIV infection, infection with other contagious diseases, autoimmune diseases, and second or subsequent pregnancies in women. Field observations of three community HIV testing sites and semistructured interviews with 16 HIV test counselors were conducted from August 2002 through June 2003. Counselors defined an indeterminate test result in different ways. They also presented several different theories of causation, yet failed to mention two potential causes of an indeterminate result, association with large animals and infection with other (non-HIV-1) HIV strains. Counselors' understanding of the meaning of an indeterminate HIV test result varied a great deal. Some counselors believed that an indeterminate result truly was ambiguous while others believed it was indicative of being either HIV-positive or HIV-negative. Counselors' primary advice to clients who received an indeterminate result was to retest immediately without a waiting period. Counselors reported that communicating indeterminate test results to clients was a challenging task because clients who received such a result were confused, angry, and/or mistrustful. Results highlight the need for further research to provide reliable estimates of the extensiveness of indeterminate HIV test results and to further assess the nature of counselor and client responses to indeterminate test results.

Indeterminate and discrepant rapid HIV test results in couples' HIV testing and counselling centres in Africa

“…These cases are a challenge to manage in a voluntary counselling and testing (VCT) setting. Some cases may have been due to delayed development of antibodies to HIV [21,22,36,37] or transient infection, which has been reported in infants [38-40]. Early or transient HIV infection is unlikely to be the explanation for the 95% (201) of individuals with this profile who had HIV-uninfected partners.…”

“…These may include a third rapid test as a tie-breaker, an enzyme-linked immunosorbent assay (ELISA) test for detection of antibodies and/or antigen, and HIV-RNA viral load testing [18][19][20]. Reported causes of indeterminate or discrepant rapid test results include early HIV infection [19,[21][22][23][24] and false positive reactions due to malaria, pregnancy, syphilis, hepatitis B or endemic infections [25][26][27][28][29].…”

The characteristics of screening and confirmatory test results for HIV in Xi’an, China

“…Currently, antigens such as gp41 and gp36 (Abbott Architect HIV Ag/Ab Combo and Roche Elecsys HIV Combi), gp120, gp41 and gp36 (domestic kit and Bayer ADVIA centaurg HIV 1/O/2 enhanced), gp160, gp41 and gp36 (Genscreen™ ULTRA and VIDAS DUO Ultra) are usually used to detect HIV-1/2 antibodies [13, 19, 20] with excellent sensitivity [8, 10–13, 19, 21, 22]. Many factors, such as influenza vaccination [14,15], rheumatoid factors, autoimmune diseases [15], parasitic infection [16], and pregnancy [18], may lead to poor specificity in HIV screening by the 4 th -generation assay and an indeterminate result for the WB test [23, 24]. …”

A Roadmap for Personalized Care in Radiology

“…Delineating the types and causes of clinically relevant test uncertainty can directly impact shared decision-making, and it has been shown that patients do not understand indeterminate test results and view them with suspicion and loss of confidence in health care providers and systems (34). Revisiting the case of a patient concerned about his risk for prostate cancer, prostatespecific antigen screening provides a typical example of a preferencesensitive decision.…”