HIV Laboratory Diagnosis: Minister Gives New Direction - Says Three Tests to Declare Someone Positive!

Finger prick for HIV-1/2 rapid test in a diagnostic laboratory.

In 2022, Cameroon was estimated to be home to 480 232 people living with HIV, with 9905 new cases recorded that year. Although still a major public health problem, the most recent Demographic Health Survey 2018 show recent encouraging progress which includes a 50% decrease in HIV prevalence among people aged 15 to 64 in the past 14 years, a drop in prevalence from 5.4% in 2004, to 4.3% in 2011, and 2.7% in 2018. - a great positive change in the epidemiology (distribution) of the HIV epidemic over the national territory.

According the World Health Organization 2019, in response to this changing epidemiology in Cameroon and eslewhere, countries should adopt a standard HIV testing strategy with three consecutive reactive tests for an HIV-positive diagnosis to ensure quality services. Below is an overview of the guidelines;

In response to these changes in the global HIV epidemic, WHO is encouraging countries to use three consecutive reactive tests for an HIV-positive diagnosis as their treatment-adjusted prevalence and national HTS positivity fall below 5% - WHO.

In response to the above guidelines, the Minister of Public Health, Dr. Manaouda Malachi, on July 9, 2024 issued a circular referenced D36-40/LC/MINSANTE modifying the HIV diagnostic algorithm in health facilities and in communities. He writes;

Following the results of the 2018 demographic and health survey, which revealed an estimated HIV prevalence of 2.7%, Cameroon has adopted the 2019 WHO guidelines, which recommend the use of a three-test screening algorithm in settings where the prevalence of the epidemic is less than 5%... - Dr. Manaouda Malachi, Cameroon Minister of Health

This means that, for a person from the general population to be tested and confirmed positive for HIV infection, three rapid diagnostic tests have to be used, each showing "positive" (reactive as per the diagnostic jargon) in series, replacing the two rapid diagnostic tests initially used in series.

Testing of HIV in pregnant women as per the ministerial circular has a slight modification with the addition of a first line HIV test that is associated with syphilis test. All tests have alternatives which the ministerial circular emphasized to be used only with the first choices are out of stock.

THE NEW HIV RECOMMENDED RAPID TESTS

1. GENERAL POPULATION

	FIRST CHOICE	ALTERNATIVE
1ST TEST	First Response HIV 1-2 O Card Test	Standard Q HIV Test
2ND TEST	One Step Anti-HIV (1&2) Test - INTEC	OraQuick HIV Test
3RD TEST	Diagnostic Kit for HIV (1+2) Antibody (Colloidal Gold) v2 KHB	OraQuick HIV Test

2. PREGNANT WOMEN AT ANTENATAL CONSULTATIONS AND KEY POPULATION

	FIRST CHOICE	ALTERNATIVE
1ST TEST	First Response HIV 1+2/Syphilis Combo Card Test	Standard Q HIV Test/Syphilis Combo Test
2ND TEST	One Step Anti-HIV (1&2) Test - INTEC	OraQuick HIV Test
3RD TEST	Diagnostic Kit for HIV (1+2) Antibody (Colloidal Gold) v2 KHB	OraQuick HIV Test

Note that this modification completely takes off a very popular HIV test called Determine HIV1/2 as well as UniGold HIV1/2 from the Cameroon's healthcare system.

Cameroonians are called upon to understand that health facilities are meant to implement the policies of the Ministry of Public Health for best health outcomes. Therefore, ensuring that the services offered them align with these policies is the only guarantee that they have received quality service - Nkengacha M. Agendia, President HELP Foundation.

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