American Journal of Epidemiology Vol. 136, No. 2: 244-255
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
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Issues in Human Immunodeficiency Virus (HIV) Screening Programs
1Department of Biostatistics, Harvard School of Public Health Boston, MA
2Department of Health Policy and Management, Harvard School of Public Health Boston, MA
Reprint requests to Dr. Marcello Pagano, Department of Biostatistics, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115
Unlike test sensitivity and specificity, the false positive and negative predictive values (probabilities of mislabeling an individual being tested) depend heavily on the prevalence of the infection of the human immunodeficiency virus (HIV) as well as the quality of the kit. A consequence of this dependence is that the false positive predictive value can reach a high magnitude such as 0.9; that is, 90% of the positive tests are false. This raises many important issues pertaining to the current practice of HIV screening such as to how to control these misclassification errors, how to interpret test results, and how to estimate prevalence using test results. These issues are examined in detail here by considering the factors that dictate the quality of a screening program. Some real data examples are used to illustrate the importance of this consideration in designing programs to achieve the desired goals. The rationale behind the common two-step sequential protocol in HIV screening is examined to point out its limitations under practical situations. Finally, the use of entropy in evaluating the informativeness of a screening program is discussed. Am J Epidemiol 1992;136:244–55.
bias (epidemiology); HIV; information theory; predictive value of tests; sensitivity and specificity (epidemiology)
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