Review Article

Pooled testing: A tool to increase efficiency of infant HIV diagnosis and virological monitoring

Wolfgang Preiser, Gert U. van Zyl
African Journal of Laboratory Medicine | Vol 9, No 2 | a1035 | DOI: https://doi.org/10.4102/ajlm.v9i2.1035 | © 2020 Wolfgang Preiser, Gert U. van Zyl | This work is licensed under CC Attribution 4.0
Submitted: 24 April 2019 | Published: 11 August 2020

About the author(s)

Wolfgang Preiser, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa
Gert U. van Zyl, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service (NHLS) Tygerberg, Cape Town, South Africa


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Abstract

Background: Pooled testing, or pooling, has been used for decades to efficiently diagnose relatively rare conditions, such as infection in blood donors. Programmes for the prevention of mother-to-child transmission of HIV and for antiretroviral therapy (ART) are being rolled out in much of Africa and are largely successful. This increases the need for early infant diagnosis (EID) of HIV using qualitative nucleic acid testing and for virological monitoring of patients on ART using viral load testing. While numbers of patients needing testing are increasing, infant HIV infections and ART failures are becoming rarer, opening an opportunity for pooled testing approaches.

Aim: This review highlights the need for universal EID and viral load coverage as well as the challenges faced. We introduce the concept of pooled testing and highlight some important considerations before giving an overview of studies exploring pooled testing for EID and virological monitoring.

Results: For ART monitoring, pooling has been shown to be accurate and efficient; for EID it has not been tried although modelling shows it to be promising. The final part attempts to place pooling into the context of current mother-to-child transmission of HIV and ART programmes and their expected trajectories over the next years.

Conclusion: Several points warrant consideration: pre-selection to exclude samples with an elevated pre-test probability of positivity from pooled testing, the use of dried blood or plasma spots, and choosing a pooling strategy that is both practically feasible and economical. Finally, novel ideas are suggested to make pooling even more attractive.


Keywords

HIV; antiretroviral treatment; early infant diagnosis; pooling; pooled testing

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