Discordant HIV Test Results: Implications on Perinatal and...

Research ArticleDiscordant HIV Test Results Implications onPerinatal and Haemotransfusion Screening forHIV Infection Cape Coast Ghana

Ato Kwamena Tetteh1 and Edward Agyarko2

1Laboratory Department Metropolitan Hospital PO Box 174 Cape Coast Ghana2Department of Community Medicine and Health Anglican University College of Technology PO Box 74 Nkoranza Ghana

Correspondence should be addressed to Ato Kwamena Tetteh aktettehoutlookcom

Received 5 July 2017 Accepted 29 August 2017 Published 8 October 2017

Academic Editor Hsin-Yun Sun

Copyright copy 2017 Ato Kwamena Tetteh and Edward Agyarko This is an open access article distributed under the CreativeCommons Attribution License which permits unrestricted use distribution and reproduction in any medium provided theoriginal work is properly cited

Screening results of 488 pregnant women aged 15ndash44 years whose blood samples had been tested on-site using First ResponseHIV 12 and confirmed with INNO-LIAHIV III Score were used Of this total 178 were reactive (HIV I 154 HIV II 2 and HIVI and HIV II 22) Of the 154 HIV I-reactive samples 104 were confirmed to be HIV I-positive and 2 were confirmed to be HIV II-positive while 48 were confirmed to be negative [false positive rate = 1744 (1356ndash2132)]The twoHIV II samples submitted wereconfirmed to be negative with the confirmatory test For the 22 HIV I and HIV II samples 7 were confirmed to be HIV I-positiveand 1 was confirmed to be HIV I- and HIV II-positive while 14 were confirmed to be negative Of the 310 nonreactive samples 6were confirmed to be HIV I-positive and 1 was confirmed to be HIV II-positive [false negative rate = 579 (163ndash838)] while 303were negative False negative outcomes will remain unconfirmed with no management options for the client False negative rate of579 requires attention as its resultant implications on control of HIVAIDS could be dire

1 Introduction

Practically the only way children below 5 years of age inGhana could be infected with the Human Immunodefi-ciency Virus (HIV) is through the mother-to-child modeor haemotransfusion Without interventions to minimizevertical transmission nearly 30 of infected expectant andbreastfeeding mothers would add more children every yearto those previously infected [1] It is expected that up to45 of children born to HIV positive mothers in lowresourced countries will become infected [2] Concurrentdiagnosis of infection antiretroviral therapy (ART) saferobstetric practice and infant feeding counseling and sup-port can reduce the risk to lt2 [3ndash5] Interventions forprevention of vertical transmission of HIV were piloted inGhana with support from UNICEF and other United NationAgencies at Atua and St Martin de Porres Hospital in ManyaKrobo District Eastern Region from December 2001 [1]There is currently an existing protocol in all health centres

polyclinics districtmunicipalmetropolitan hospitals andregionalteaching hospitals throughout Ghana which pro-vides antenatal care (ANC) as well as prevention of mother-to-child transmission (PMTCT) interventions

Recently the Ministry of HealthGhana Health Servicehas established that up to 95 of all pregnant women inGhana make at least one ANC visit By this they accessPMTCT for HIV interventions Health facilities that providePMTCT services engage the women and their families in acontinuum of HIV prevention care and treatment servicesThe First Response HIV 12 test kit has been adopted for useas initialscreening test at the antenatal care units and also forblood safety throughout Ghana For this test if the controlband alone appears the test is considered ldquononreactiverdquoand therefore ldquonegativerdquo The test result is concluded asldquonegativerdquo If the test band appears in addition to the controlband the test is reactive and a supplementary test usinga more sensitive rapid HIV test (OraQuick HIV-12) isemployed for confirmation of positivity Initial tests offer the

HindawiJournal of Sexually Transmitted DiseasesVolume 2017 Article ID 2857397 6 pageshttpsdoiorg10115520172857397

2 Journal of Sexually Transmitted Diseases

Major towns

Cape Coast MetroDistrict boundary

0 25 5 10

(km)

Figure 1 Map of Cape Coast Metropolitan Area (Credit Dr Charles Gyamfi Department of Civil Engineering Tshwane University ofTechnology Pretoria South Africa)

presumptive detection of antibody-positive specimens andsupplementary tests are used to validate whether specimenscontain antibodies explicit to HIV A reactive supplementarytest result is indicative of a true positive result In a caseof indeterminate results between these two initial testsa laboratory-based Enzyme-Linked Immunosorbent Assay(ELISA) test is performed at the Public Health ReferenceLaboratory Korle-Bu Accra Ghana This study presentsevidence (from the 2010ndash2016 HIV Sentinel Survey Data)of the likelihood of obtaining false negative HIV test resultsusing First Response HIV 12 alone at PMTCT centres andduring blood donor screening

Since 1992 the National HIV Prevalence Extrapolationshave been derived from the HIV Sentinel Survey (HSS)This is a nationwide cross-sectional survey targeting preg-nant women attending antenatal clinics in selected ANCsites in Ghana Prenatal women have been the target ofmany seroprevalence studies because they are generallyrepresentative of all women of reproductive age and theyprovide an accessible cohort for HIV testing and a securesampling frame [6ndash8] Data collection for sentinel surveysre through (urbansuburban) prenatal healthcare centresconsidered sentinel sites and nonrandom selection of sitescan substantially affect results This HSS is the primary datasource for HIV prevalence in Ghana It has been based on theprinciple that prevalence of HIV among pregnant women isa good proxy indicator of the spread of the infection amongthe general population [9] The methodology and prevalenceestimation are adequately explained in all editions of the HSSreport

The Metropolitan Hospital is one of 40 ANC sentinelsites which draws blood samples for on-site preliminary

First Response HIV 12 testing Subsequently plasma fromindividual samples is separated into 12ml cryogenic vialsand sent to the PHRL After supplementary testing usingimmunoblot (INNO-LIA HIV III Score) at the PHRLtest results are returned to participating facilities Resultscompiled over the past seven years at the MetropolitanHospital Cape Coast are indicative of both false positiveand false negative rates which are biologically significant andcould have dire consequences on infants and mothers Ofprincipal concern is the fact that women whose tests turnout to be negative at the PMTCT centres will go throughthe ANC without the appropriate intervention Also blooddonors whose preliminary tests turn out to be negative willbe bled and discharged We recognize that interventions forPMTCT and blood donor screening in Ghana over the yearshave not included continuous reassessment for the fidelityof testing protocols This article presents ldquoprima facierdquo aretrospective analysis on the implications of probable falsenegative and false positive results which could culminatefrom the sole use of First Response HIV 12 test at PMTCTcentres and for blood donor screening

2 Materials and Methods

21 Study Area TheCapeCoastMetropolitanArea (Figure 1)is the capital of Central Region Ghana It is bounded on thesouth by the Gulf of Guinea on the west by KomendaEdinaEguafoAbirem Municipal on the east by the AburaAsebuKwamankese District and on the north by the TwifoHemangLower Denkyira District (Figure 1) The metropoliscovers an area of 122 km2 and it is located on longitude1∘151015840Wand latitude 5∘061015840NThe population of the metropolis

Journal of Sexually Transmitted Diseases 3

according to 2010 population and housing census stands at169894 with 82810 males and 87084 females [10] The CapeCoast metropolis experiences high temperatures throughoutthe year The hottest months are February and March justbefore the main rainy season while the coolest months areJune July and August The metropolis has an annual rainfalltotal between 750 and 1000mm The present vegetation ofthe metropolis consists of shrubs of about 15m high grassesand a few scattered trees The original vegetation of densescrub which the rainfall supported has been replaced bysecondary vegetation as a result of clearing for farmingcharcoal burning bush fires and other human activitiesPresently trees are less dense in the area compared with theinterior forest areas Coastal dwellers are mostly fisher folksThe area is also considered an educational hub inGhana withsome of the best colleges in Ghana

22 Study Site TheMetropolitan Hospital is one of the fortynationwide sites participating yearly in Ghanarsquos HSS Overthe past 24 years the hospital has been able to consistentlyprovide at least the minimum number of clients necessaryto be included in the survey The site also satisfies all criteriarequired for participation in the HIV Sentinel Survey (HSS)which are adequately listed in the 2015 HSS report [11] Toparticipate one must be pregnant must have an age between15ndash49 years and must be attending antenatal clinic for thefirst time during the current pregnancy within the surveyperiod

23 Population The HSS survey targets all antenatal care(ANC) women aged between 15 and 49 years who wereattending ANC clinic for the first time during their currentpregnancy within the survey period Pregnant women onrepeat visit to the ANC during the period were excluded asset out by theHSS protocolThe expected sample size for eachANC site was 500 with an acceptable minimum of 251

24 Study Design This retrospective study made use of HIVSentinel Survey data compiled over the last seven years atthe Metropolitan Hospital Data has already been used toestimate the national HIV prevalence and data recordingbooks returned to the Metropolitan Hospital We foundrelevance in commenting on the discordant results realized inthe past seven years in the testing of HIV among the pregnantwomen

25 Ethical Consideration Written informed consent wasobtained from each study participant and the study wasperformed in accordance with the Declaration of Helsinki(1964)

26 Blood Sample Collection Samples were taken from par-ticipants who met the eligibility and inclusion criteria setby the National AIDsSTI Control Programme The closedsystem of blood draw (BD Vacutainer needles and evacuated5ml K

3EDTA tubes) was used in obtaining approximately

35ndash4ml of whole blood Samples that were not tested on thesame day were stored at 2ndash8∘C and tested before the end of 72hours

27 On-Site HIV Testing Samples were centrifuged to com-pletely separate plasma from blood corpuscles PreliminaryHIV testing was done using the First Response HIV 12test kits as per manufacturerrsquos instruction Following thisthe remaining plasma was transferred using Pasteur Pipettesinto 12ml cryogenic vials and labeled appropriately withparticipant site code age and test results

28 Testing at the PHRL Plasma (both reactive and non-reactive) was stored at minus20∘C till the end of the surveyperiod and transported to the PHRL where the confirmatorytesting is done using immunoblot INNO-LIAHIV III ScoreThroughout the period under study all reactive sampleshad been confirmed by the PHRL In addition 10 of allnonreactive samples were randomly selected from the siteand tested

29 Data Analysis All data that had been previously enteredinto a site register were recoded to seclude participantsrsquoidentity and entered into Microsoft Excel This was latercleaned by removing test results that were not confirmed andsubsequently exported into SPSS (Version 200 SPSS IncChicago IL) which was used for the analysis Frequencydistribution of age groups and crosstabulations for both testswere done Summarily the study is concentrated on thebiological significance of probable clinical outcome of theresults The following parameters were also deduced to aiddiscussion

sensitivity = 119886(119886 + 119888)

specificity = 119889(119887 + 119889)

false positive rate = 119887(119887 + 119889)

false negative rate = 119888(119886 + 119888)

(1)

where 119886 denotes true positive 119887 denotes false positive 119888denotes false negative 119889 denotes true negative

3 Results

31 Demographic Characteristics forThis Study A total of 488participants who attended antenatal clinic at the Metropoli-tan Hospital within the survey period whose initial testresults got confirmed were included in the following analysisThis number included all yearly reactive test samples and10 randomly selected nonreactive samples Participantsranged between 15 and 44 years (mean age 2609 yearsmode 23 years standard deviation 6511 years) Majority ofthe participants were within the age group of 15ndash34 yearsParticipants who were ge35 years old constituted the minority(Table 1)

32 Yearly Summaries of Samples Submitted Over the pastseven years 3245 plasma samples have been submitted bythe Metropolitan Hospital to the PHRL for confirmation


Table 1 Age ranges of participants

Age range (years) Number of participants ()15ndash24 218 (447)25ndash34 205 (420)35ndash44 65 (133)Total 488

22

96

2816 20 26 30

0

2

4

6

8

10

12

Prev

alen

ce (

)

2011 2012 2013 2014 2015 20162010Sentinel Year

Figure 2MetropolitanHospital HIV prevalence trend (2010ndash2016)

(Table 2) In total preliminary on-site testing showed that 154were HIV I-reactive and two were HIV II-reactive while 22were HIV I- and HIV II-reactive

33 Seroprevalence of HIV Infection (2010ndash2016) Estimatedprevalence for Cape Coast over the period was extractedfrom the 2016 HIV Sentinel Survey report and used to obtainFigure 2 With the exception of year 2011 which recordedthe highest prevalence ever (96) in the history of HIV inCape Coast the remaining were le30 For all these yearsour laboratory submitted the required number of samplesnecessary to participate in the Sentinel Survey

34 Distribution of Serotypes among Age Groups Of the 488samples selected for confirmation over the seven-year period178 were reactive while 310 were nonreactive (Table 3)Specifically 154178 were HIV I-reactive and 2 were HIV II-reactive while 22 were HIV I- and HIV II-reactive Out of218 participants in the 15ndash24 years category 81 were reactivefor at least one of the different serotypes Likewise 69 and27 participants in the age groups of 25ndash34 and 35ndash44 yearsrespectively were reactive

35 Crosstabulation of Preliminary and Confirmatory TestsThe more sensitive INNO-LIA HIV III Score was usedas a standard against which sensitivity and specificity ofthe First Response HIV 12 were estimated (Table 4) Afterconfirmatory testing 121488 were reactive while 367 werenonreactive [sensitivity = 9421 (9006ndash9837) specificity= 8256 (7868ndash8644)] Of the 154 HIV I-reactive sam-ples submitted 104 were confirmed to be HIV I-positiveand 2 were confirmed to be HIV II-positive while 48were confirmed to be negative [false positive rate = 1744(1356ndash2132)] The two HIV II samples submitted wereconfirmed to be negative with the confirmatory test For the

22 HIV I and HIV II samples submitted 7 were confirmedto be HIV I-positive and only one was confirmed to beHIV I- and HIV II-positive while the remaining 14 wereconfirmed to be negative Of the 310 nonreactive samples 6were confirmed to be HIV I-positive and 1 was confirmed tobe HIV II-positive [false negative rate = 579 (163ndash838)]while the remaining 303 were negative

4 Discussion

HIV prevalence result of the 7-year period under study wasle30 with the exception of the year 2011 which recordedthe highest value of 96 The Metropolitan Hospital wherethis prevalence was recorded drew attention nationwide ThePublic Health Reference Laboratory retested all samples for2011 Later a general survey was conducted for the areabefore results for the year were accepted and included in thenationwide HIV Sentinel Survey Reference is made to theMarch 2011 second civil war in Ivory Coast where majorityof Ghanaian residents returned to Ghana Due to the civilunrest a refugee camp called ldquoEgyirkromRefugeeCamprdquowasset up by the Government of Ghana at Egyirkrom about 20kilometers from Cape Coast This camp hosted GhanaiansIvorians and other Nationalities who came to the CentralRegion to seek refuge Ghanaian returnees who reunited withfamilies or got integrated into society and other refugeesmight have sought antenatal care between September andDecember 2011 at the Metropolitan Hospital which servesas the first referral centre and could probably have addedto the existing prevalence We decided not to conclude onthis subtle explanation because it had come from a plenarydiscussion and not from scientific evidence We would liketo emphasize that this study rather focused on discordantoutcomes detected at the Metropolitan Hospital (an HIVSentinel Testing site) Cape Coast Ghana

The eventual consequence of misdiagnosing HIV infec-tion in pregnant women and blood donors could be disas-trous for Ghana and Africa as a whole as it could frustratestrategic efforts aimed at controlling the spread It is generallyaccepted that knowledge of HIV status is significant inincreasing access to HIV treatment care and support in atimely manner It grants people living with HIV an oppor-tunity to receive information and tools to grossly minimizeHIV transmission to others and also increases the impact ofantiretroviral treatment (ART) [12] Key policies are alreadyunder implementation to curb the rate of spread

In all HIV testing services it is essential that the resultsgiven to individuals be reliable According to WHO recom-mendations HIV testing methods should have sensitivityof at least 99 and specificity of at least 98 This meansthat the test should give a positive result when the conditionis present at least 99 of the time and the test must alsogive a negative result at least 98 of the time when thepatient does not have the condition [13] We recognize thatthe most consistent screening methods especially nucleicacid amplification testing technologies [14] which allow forvery early detection are costly and cannot be used routinelyin low-resourced countries It is however important thatpreliminary test kits be monitored consistently against more


Table 2 Summaries of samples collected and results obtained

Year Number of samples collected Test results (First Response HIV 12)HIV I HIV II HIV I and HIV II

2010 500 25 mdash 142011 500 64 mdash 32012 500 19 mdash 22013 500 12 1 12014 391 10 1 22015 389 10 mdash mdash2016 465 14 mdash mdash

Table 3 Prevalence of serotypes among age groups

Age (years) Reactive (First Response HIV 12) Nonreactive TotalHIV I HIV II HIV I and HIV II

15ndash24 71 2 8 137 21825ndash34 61 0 8 136 20535ndash44 22 0 6 37 65Total 154 2 22 310 488

Table 4 Crosstabulation of initial and supplementary tests

First Response HIV 12 INNO-LIA HIV III Score TotalHIV I HIV II HIV I and HIV II NRlowast

HIV I 104 2 mdash 48 154HIV II mdash mdash mdash 2 2HIV I and HIV II 7 mdash 1 14 22NRlowast 6 1 mdash 303 310Total 117 3 1 367 488NRlowast nonreactive Sensitivity = 9421 (9006ndash9837) specificity = 8256 (7868ndash8644) false positive rate = 1744 (1356ndash2132) false negative rate = 579(163ndash838)

sensitive methods before they are used at testing centres suchas the prevention of mother-to-child transmission (PMTCT)and donor screening laboratories Without this a goodproportion of infected pregnant and breastfeeding womenwould add children to the pool of those already infectedyearly [1] especially when most screened blood is given topregnant women in Ghana

In this study the INNO-LIA HIV III Score test kit(sensitivity = 100 specificity = 967) was used as a standardagainst which the sensitivity of the First Response HIV12was estimated Sensitivity and specificity of 9421 and 8256respectively were estimated for the period under reviewWe suggest the use of a parallel algorithm which tests allspecimens with two rapid tests and resolve discordant resultsby retestingwith a third tiebreaker test [12] in the near futureespecially for pregnant women and blood donors

From the results 121 out of the 178 positive results(representing 68) were confirmed to be positive Thus32 of the samples were false positive (false positive rate =1744 CI 1356ndash2132) With the existing testing protocol forHIV in Ghana all false positive outcomes will be confirmedwith OraQuick HIV-12 just as true positive outcomes at

the PMTCT centres while blood donors will fail outrightand will be directed to the designated counseling unitsfor further attention With this the popular issues relatedto stigma and discrimination attendant psychological andsocial consequences domestic violence and exposure tothe unnecessary and potentially toxic medical treatment areavoided to some extent

This study detected false negative outcomes Out of thetotal 23 of the nonreactive samples turned out to be falsenegative (false negative rate = 579 (163ndash838)) Althoughthis rate looks small in percentage terms it has a majorbiological significance in terms of the eventual consequenceFalse negative outcomes are a threat not only to publichealth prevention strategies but also to the health and well-being of the individuals A false negative diagnosis despitebeing incorrect may prevent patients from seeking out othertesting opportunities taking the necessary precautions toprevent the transmission of HIV and receiving the careand treatment that they need [15] Without the necessaryobstetric precautions and ART in pregnant women who arefalsely diagnosed there is an increased chance of perinataltransmission


5 Conclusion

We would like to emphasize that it is important to maintainthe integrity of PMTCT and blood donor testing of HIV byensuring the reliability of the testing methods In order toimprove detection of HIV we suggest that efforts should bemade to always providemore sensitive supplementary testingno matter the outcome of the preliminary test at the PMTCTcentres and also during donor blood screening

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this article

Authorsrsquo Contributions

Ato Kwamena Tetteh designed the study compiled analyzedand interpreted the data and drafted themanuscript EdwardAgyarko conceptualized the need for such a study andcontributed immensely to data analysis and interpretationwriting of the introduction and discussion of this article

Acknowledgments

The authorsrsquo appreciation goes to the Global Fund to FightAIDS Tuberculosis and Malaria for providing support overthe years to the Ghana Health Service and the NationalAIDSSTI Control Programme (NACP) They also thankthe laboratory staff and the nurses at the PMTCT centreMetropolitan Hospital Cape Coast for their support Finallythey thank Dr Charles Gyamfi Department of Civil Engi-neering Tshwane University of Technology Pretoria SouthAfrica for providing them with the map of Cape Coast

References

[1] Prevention of Mother-to-Child Transmission of HIV in GhanaScale-up Plan 2011ndash2015 Ministry of HealthGhana HealthService 2010

[2] K M de Cock M G Fowler E Mercier et al ldquoPrevention ofmother-to-child HIV transmission in resource-poor countriestranslating research into policy and practicerdquo The Journal ofthe American Medical Association vol 283 no 9 pp 1175ndash11822000

[3] E R Cooper M Charurat L Mofenson et al ldquoCombinationantiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmis-sionrdquo Journal of Acquired ImmuneDeficiency Syndromes vol 29no 5 pp 484ndash494 2002

[4] Centers for Disease Control and Prevention (CDC) Achieve-ments in public health Reduction in perinatal transmissionof HIV infectionmdashUnited States 1985-2005 MMWR (MorbMortal Wkly Rep) vol 55 pp 592-7 2006

[5] C Thorne M-L Newell L Gray S Fiore and C S PeckhamldquoHIV-infected pregnant women and vertical transmission inEurope since 1986rdquo AIDS vol 15 no 6 pp 761ndash770 2001

[6] R L Colebunders and W L Heyward ldquoSurveillance of AIDSandHIV infection opportunities and challengesrdquoHealth policyvol 15 no 1 pp 1ndash11 1990

[7] J M Karon P S Rosenberg G Mcquillan M Khare MGwinn and L R Petersen ldquoPrevalence of HIV infection in theUS 1984 to 1992rdquo JAMA vol 276 no 2 pp 126ndash131 1984

[8] E Boisson A Nicoll B Zaba and L C Rodrigues ldquoInterpret-ing HIV seroprevalence data from pregnant womenrdquo Journal ofAcquired Immune Deficiency Syndromes and Human Retrovirol-ogy vol 13 no 5 pp 434ndash439 1996

[9] A R Neequaye J A Mingle and J E Neequaye ldquoA report ofhuman immunodeficiency virus (HIV) infection in Ghana upto Decemberrdquo Ghana Med J vol 21 pp 7ndash11 1986

[10] Ghana Statistical Service Population and Housing CensusCentral Regional Analytical Report 2010

[11] HIV Sentinel Survey Report National AIDSSTI Control Pro-gramme Ghana Health Service

[12] HIV Diagnosis a guide for selecting rapid diagnostic test (rdt)kits UNICEF 2008

[13] A F Aghokeng EMpoudi-Ngole H Dimodi et al ldquoInaccuratediagnosis ofHIV-1 groupMandO is a key challenge for ongoinguniversal access to antiretroviral treatment andHIV preventionin Cameroonrdquo PLoS ONE vol 4 no 11 Article ID e7702 2009

[14] M P Busch S L Stramer and S H Kleinman ldquoEvolvingapplications of nucleic acid amplification assays for preventionof virus transmission by blood components and derivativesrdquoin Applications of Molecular Biology in Blood Transfusion GGarraty Ed pp 123ndash176 American Association of BloodBanks Bethesda Md USA 1997

[15] M P Petticrew A J Sowden D Lister-Sharp and K WrightldquoFalse-negative results in screening programmes Systematicreview of impact and implicationsrdquo Health Technology Assess-ment vol 4 no 5 2000

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The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

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Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


Major towns

Cape Coast MetroDistrict boundary

0 25 5 10

(km)

Figure 1 Map of Cape Coast Metropolitan Area (Credit Dr Charles Gyamfi Department of Civil Engineering Tshwane University ofTechnology Pretoria South Africa)

presumptive detection of antibody-positive specimens andsupplementary tests are used to validate whether specimenscontain antibodies explicit to HIV A reactive supplementarytest result is indicative of a true positive result In a caseof indeterminate results between these two initial testsa laboratory-based Enzyme-Linked Immunosorbent Assay(ELISA) test is performed at the Public Health ReferenceLaboratory Korle-Bu Accra Ghana This study presentsevidence (from the 2010ndash2016 HIV Sentinel Survey Data)of the likelihood of obtaining false negative HIV test resultsusing First Response HIV 12 alone at PMTCT centres andduring blood donor screening

Since 1992 the National HIV Prevalence Extrapolationshave been derived from the HIV Sentinel Survey (HSS)This is a nationwide cross-sectional survey targeting preg-nant women attending antenatal clinics in selected ANCsites in Ghana Prenatal women have been the target ofmany seroprevalence studies because they are generallyrepresentative of all women of reproductive age and theyprovide an accessible cohort for HIV testing and a securesampling frame [6ndash8] Data collection for sentinel surveysre through (urbansuburban) prenatal healthcare centresconsidered sentinel sites and nonrandom selection of sitescan substantially affect results This HSS is the primary datasource for HIV prevalence in Ghana It has been based on theprinciple that prevalence of HIV among pregnant women isa good proxy indicator of the spread of the infection amongthe general population [9] The methodology and prevalenceestimation are adequately explained in all editions of the HSSreport

The Metropolitan Hospital is one of 40 ANC sentinelsites which draws blood samples for on-site preliminary

First Response HIV 12 testing Subsequently plasma fromindividual samples is separated into 12ml cryogenic vialsand sent to the PHRL After supplementary testing usingimmunoblot (INNO-LIA HIV III Score) at the PHRLtest results are returned to participating facilities Resultscompiled over the past seven years at the MetropolitanHospital Cape Coast are indicative of both false positiveand false negative rates which are biologically significant andcould have dire consequences on infants and mothers Ofprincipal concern is the fact that women whose tests turnout to be negative at the PMTCT centres will go throughthe ANC without the appropriate intervention Also blooddonors whose preliminary tests turn out to be negative willbe bled and discharged We recognize that interventions forPMTCT and blood donor screening in Ghana over the yearshave not included continuous reassessment for the fidelityof testing protocols This article presents ldquoprima facierdquo aretrospective analysis on the implications of probable falsenegative and false positive results which could culminatefrom the sole use of First Response HIV 12 test at PMTCTcentres and for blood donor screening

2 Materials and Methods

21 Study Area TheCapeCoastMetropolitanArea (Figure 1)is the capital of Central Region Ghana It is bounded on thesouth by the Gulf of Guinea on the west by KomendaEdinaEguafoAbirem Municipal on the east by the AburaAsebuKwamankese District and on the north by the TwifoHemangLower Denkyira District (Figure 1) The metropoliscovers an area of 122 km2 and it is located on longitude1∘151015840Wand latitude 5∘061015840NThe population of the metropolis













sensitivity = 119886(119886 + 119888)

specificity = 119889(119887 + 119889)



(1)


3 Results






22

96

2816 20 26 30

0

2

4

6

8

10

12

Prev

alen

ce (

)

2011 2012 2013 2014 2015 20162010Sentinel Year







4 Discussion




















5 Conclusion






Acknowledgments


References





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




























sensitivity = 119886(119886 + 119888)

specificity = 119889(119887 + 119889)



(1)


3 Results






22

96

2816 20 26 30

0

2

4

6

8

10

12

Prev

alen

ce (

)

2011 2012 2013 2014 2015 20162010Sentinel Year







4 Discussion




















5 Conclusion






Acknowledgments


References





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















22

96

2816 20 26 30

0

2

4

6

8

10

12

Prev

alen

ce (

)

2011 2012 2013 2014 2015 20162010Sentinel Year







4 Discussion




















5 Conclusion






Acknowledgments


References





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
































5 Conclusion






Acknowledgments


References





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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