Two samples were false negative, giving a specificity of 95.2% (95% CI: 89.2% to 98.4%) and NPV of 98.0% (95% CI: 93.1% to 99.8%), respectively (Table ?(Table2).2). on preembalmed and postembalmed samples compared with the gold standard. Specificity was 97.1% (95% CI: 91.9 to 99.4) and 95.2% (95% CI: 89.2 to 98.4) preembalming and postembalming, respectively. Preembalming and postembalming positive predictive value was 89.3% (95% CI: 71.8 to 97.7) and 83.3% (95% CI: 65.3 to 94.4), respectively. The area under the curve preembalming and postembalming was 94.9% (95% CI: 89.6 to 100) and 93.9% (95% CI: 88.5 to 99.4), respectively. Conclusions: The study showed a relatively high-performance sensitivity and specificity of OraQuick Rapid HIV-1/2 test among decedents, similar to those observed among living subjects. OraQuick Rapid HIV-1/2 presents a convenient and less invasive screening test for NVP-BSK805 dihydrochloride surveillance of HIV among decedents within a mortuary setting. strong class=”kwd-title” Key Words: OraQuick, HIV, rapid testing, minimally invasive CENPA HIV testing, HIV mortality surveillance INTRODUCTION The annual number of global deaths from AIDS-related illnesses among people living with HIV has declined from a peak of 1 1.7 (1.3C2.4) million in 2004 to 770,000 (570,000C1,100,000) in 2018.1 Estimates from the 2018 AIDS survey in Kenya indicate a HIV prevalence of 4.9%,2 in the same year, approximately 25,000 people died from AIDS-related illnesses. Although this is still high, the death rate has declined steadily from 64,000 in 2010 2010.3 Studies conducted among decedents in Kisumu and Nairobi, Kenya have shown a HIV prevalence of 28.5% and 20.9%, respectively.4,5 Population-level all-cause and cause-specific death rates are an important indicator of local disease epidemiology6,7 and can be used for monitoring trends in population health status.8,9 However, such reliable NVP-BSK805 dihydrochloride data are scarce, thus limiting efforts for health policy formulation, planning, monitoring, and evaluation in documenting the country’s progress towards the Sustainable Development Goals. Creating simple, routine ascertainment of HIV status among all deaths in a given jurisdiction would allow for more direct monitoring of mortality patterns in the HIV-infected population and mathematical modelling for estimation of HIV incidence. Methods for mortality surveillance NVP-BSK805 dihydrochloride in limited resource settings include conducting full or verbal autopsies (VAs) or testing for HIV from blood drawn from decedents. Verbal autopsy is a tool for retrospectively interviewing families/caregivers of the deceased to understand the circumstances that have led to death.10 VAs, in particular, have significantly contributed to the understanding of mortality in resource-limited settings but have limitations, especially for diagnosing illnesses with non-specific symptoms including HIV.11 Testing for HIV involving collection of blood through trans-thoracic needle biopsies or intravenous methods have been used previously and found to be feasible.4,12 However, in some populations, blood collection is not well accepted for religious or cultural reasons.13 Additionally, using blood samples for HIV testing can be logistically challenging because of factors such as safety during collection and handling during transportation to testing point. Samples collected using noninvasive techniques such as oral fluids14,15 provide a viable alternative. In the past 2 decades, oral fluid was introduced as an additional sample type to plasma, dried blood spots (DBSs), and serum for HIV antibody-based assays,14,16 and one that is preferred over blood-based testing.17,18 Oral fluid rapid HIV assays have only been validated among living persons. With the possibility of using this sample type for HIV-related mortality surveillance, we set out to evaluate the performance of OraQuick Rapid HIV-1/2 test kit among decedents. The assay performance was evaluated in both preembalmed and postembalmed specimens to determine if the embalming process would interfere with the kit functionality. The specificity and sensitivity of the OraQuick Rapid HIV-1/2 antibody test on the oral fluids from decedents was compared with the results obtained from matched whole blood specimen using the national HIV testing algorithm.19 These findings will be used to inform HIV-associated mortality surveillance systems, policy, planning, monitoring, and evaluation in the country. METHODS Study Setting, Participants, and Sample Size This substudy was part of a larger cross-sectional HIV surveillance study carried out between April 16, 2019 and July 12, 2019, among decedents admitted to the Jaramogi NVP-BSK805 dihydrochloride NVP-BSK805 dihydrochloride Oginga Odinga Teaching and Referral Hospital mortuary,20 Kisumu County, in the Nyanza region of.
