Efficacy of integrated rapid diagnostic testing for HIV, syphilis and hepatitis in Zimbabwe

Background: Triple point-of-care tests for simultaneous detection of human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV) make service delivery simple, reduce costs and time for testing, and lower supply chain barriers. The performance of such antenatal care (ANC) panel has not been evaluated in Zimbabwe. Aim: The aim of the study was to compare the performance of the ANC panel with standard testing. Setting: The study was carried out in Mudzi District, Zimbabwe. Methods: An analytical cross-sectional design was followed to compare the performance of HIV/syphilis/HBV surface antigen (HBsAg) rapid diagnostic tests against standard of screening done using individual testing devices. Reference tests had HIV and syphilis on one strip and HBV on a separate strip. Data were collected between May and October 2024 at nine clinics and one hospital. In all, 284 participants took part in the study. Informed consent was obtained before data collection. A finger-prick sample was tested. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were determined against routine testing. Results: The results were 100.00% for HIV and syphilis on sensitivity, specificity, PPV and NPV. The HIV and syphilis proportions were 2.46% and 2.11%, respectively. Specificity and NPV for HBV were 100.00%. Sensitivity and PPV for HBV were not evaluated because there were no positive cases. Overall, the panel and routine testing had same results across all the three infections. Conclusion: The panel produced the same efficacy as routine care for simultaneous screening of the infections and is recommended for point-of-care use. Contribution: This evidence supports effectiveness of integrated testing as an alternative to routine care.