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Saboor Soomro R, Shah IA, Saboor A, Bhutto AUB, Memon S. Sensitivity and Specificity of Hepatitis B Virus Screening via Rapid Immunoassay Chromatographic Test. Cureus 2021; 13:e12909. [PMID: 33654594 PMCID: PMC7906272 DOI: 10.7759/cureus.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In low-income and high hepatitis B and C virus burden countries like Pakistan, it is important to develop cheap yet efficient strategies in diagnosing as well as treating hepatitis. The aim of this study is to assess the sensitivity and specificity of serum hepatitis B surface antigen (HbsAg) via Rapid Immunoassay Chromatographic Test (RICT) for the screening of hepatitis B, compared to the gold standard laboratory-based method. Methods: The study was conducted in the Hepatology Clinic of Civil Hospital, Sukkur. All records of the clinic from June 1, 2018, to December 31, 2018, were accessed for identification of the records in which hepatitis B screening via RICT and then confirmatory polymerase chair reaction (PCR) by gene amplification with forward and reverse primers was done. Results: There were 151 samples in this study. There were 32 (94.1%) true-positive and three (5.8%) false-negative samples. There were two (2.5%) false-positive and 114 (97.4%) true-negative samples. The sensitivity of HbsAg detection via RICT for the screening of 1-1B V was 91.43%, specificity was 98.28% and the accuracy was 96.69%, compared to PCR. Conclusion: The RICT method has high sensitivity and specificity. In low-income and high-hepatitis B virus-burden countries like Pakistan, it serves as a very efficient screening tool that is easy to use, cheaper in cost, and gives rapid and accurate results.
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Affiliation(s)
| | - Iftikhar Ali Shah
- Internal Medicine, Ghulam Muhammad Mahar Medical College Hospital, Sukkur, PAK
| | - Abdul Saboor
- Urology, Ghulam Muhammad Mahar Medical College Hospital, Sukkur, PAK
| | | | - Sidra Memon
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Diagnostic accuracy of tests to detect hepatitis B surface antigen: a systematic review of the literature and meta-analysis. BMC Infect Dis 2017; 17:698. [PMID: 29143619 PMCID: PMC5688498 DOI: 10.1186/s12879-017-2772-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic Hepatitis B Virus (HBV) infection is characterised by the persistence of hepatitis B surface antigen (HBsAg). Expanding HBV diagnosis and treatment programmes into low resource settings will require high quality but inexpensive rapid diagnostic tests (RDTs) in addition to laboratory-based enzyme immunoassays (EIAs) to detect HBsAg. The purpose of this review is to assess the clinical accuracy of available diagnostic tests to detect HBsAg to inform recommendations on testing strategies in 2017 WHO hepatitis testing guidelines. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using 9 databases. Two reviewers independently extracted data according to a pre-specified plan and evaluated study quality. Meta-analysis was performed. HBsAg diagnostic accuracy of rapid diagnostic tests (RDTs) was compared to enzyme immunoassay (EIA) and nucleic-acid test (NAT) reference standards. Subanalyses were performed to determine accuracy among brands, HIV-status and specimen type. RESULTS Of the 40 studies that met the inclusion criteria, 33 compared RDTs and/or EIAs against EIAs and 7 against NATs as reference standards. Thirty studies assessed diagnostic accuracy of 33 brands of RDTs in 23,716 individuals from 23 countries using EIA as the reference standard. The pooled sensitivity and specificity were 90.0% (95% CI: 89.1, 90.8) and 99.5% (95% CI: 99.4, 99.5) respectively, but accuracy varied widely among brands. Accuracy did not differ significantly whether serum, plasma, venous or capillary whole blood was used. Pooled sensitivity of RDTs in 5 studies of HIV-positive persons was lower at 72.3% (95% CI: 67.9, 76.4) compared to that in HIV-negative persons, but specificity remained high. Five studies evaluated 8 EIAs against a chemiluminescence immunoassay reference standard with a pooled sensitivity and specificity of 88.9% (95% CI: 87.0, 90.6) and 98.4% (95% CI: 97.8, 98.8), respectively. Accuracy of both RDTs and EIAs using a NAT reference were generally lower, especially amongst HIV-positive cohorts. CONCLUSIONS HBsAg RDTs have good sensitivity and excellent specificity compared to laboratory immunoassays as a reference standard. Sensitivity of HBsAg RDTs may be lower in HIV infected individuals.
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Kim SK, Hwang SH, Oh HB. Serological tests for the diagnosis of infectious diseases. BIOCHIP JOURNAL 2016. [DOI: 10.1007/s13206-016-0410-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Njai HF, Shimakawa Y, Sanneh B, Ferguson L, Ndow G, Mendy M, Sow A, Lo G, Toure-Kane C, Tanaka J, Taal M, D'alessandro U, Njie R, Thursz M, Lemoine M. Validation of rapid point-of-care (POC) tests for detection of hepatitis B surface antigen in field and laboratory settings in the Gambia, Western Africa. J Clin Microbiol 2015; 53:1156-63. [PMID: 25631805 PMCID: PMC4365211 DOI: 10.1128/jcm.02980-14] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/20/2015] [Indexed: 01/02/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a leading cause of death in sub-Saharan Africa (SSA). Point-of-care tests for hepatitis B surface antigen (HBsAg) could be an ideal tool for a large-scale HBV screening/treatment program in SSA. Using data from the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) program, we conducted a cross-sectional study to assess the diagnostic accuracy of three point-of-care tests (Determine, Vikia, and Espline) for the detection of HBsAg in the field or a laboratory setting in the Gambia. In the field, we used finger-prick whole blood for the Determine and Vikia tests and dried blood spots for the reference standard test (AxSYM HBsAg enzyme-linked immunosorbent assay [ELISA]). In the laboratory we used serum for the Determine, Espline, and reference test (Architect chemiluminescent microparticle immunoassay). Of 773 participants recruited at the community and 227 known chronic HBV carriers (1,000 subjects in total), 293 were positive for HBsAg. The sensitivity and specificity of the Determine test were 88.5% and 100% in the field and 95.3% and 93.3% in the laboratory setting, respectively. The sensitivity and specificity were 90.0% and 99.8% for the Vikia test (in the field) and 93.9% and 94.7% for the Espline test (in the laboratory). There was no evidence that one kit was better than another. Most of the patients with false-negative results (18/19) were classified as inactive chronic carriers. In summary, the three point-of-care tests had acceptable ranges of diagnostic accuracy. These tests may represent accurate, rapid, and inexpensive alternatives to serology testing for the screening of HBV infection at field level in SSA.
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Affiliation(s)
| | - Yusuke Shimakawa
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Department of Epidemiology/Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Bakary Sanneh
- National Public Health Laboratory, Banjul, the Gambia
| | - Lynne Ferguson
- Medical Research Council Unit, the Gambia, Banjul, the Gambia
| | - Gibril Ndow
- Medical Research Council Unit, the Gambia, Banjul, the Gambia
| | - Maimuna Mendy
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, Lyon, France
| | - Amina Sow
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Gora Lo
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Junko Tanaka
- Department of Epidemiology/Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Makie Taal
- National Public Health Laboratory, Banjul, the Gambia
| | | | - Ramou Njie
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Laboratory Services and Biobank Group, International Agency for Research on Cancer, Lyon, France
| | - Mark Thursz
- Department of Hepatology, Division of Medicine, Imperial College, London, United Kingdom
| | - Maud Lemoine
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Department of Hepatology, Division of Medicine, Imperial College, London, United Kingdom
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Khuroo MS, Khuroo NS, Khuroo MS. Accuracy of Rapid Point-of-Care Diagnostic Tests for Hepatitis B Surface Antigen-A Systematic Review and Meta-analysis. J Clin Exp Hepatol 2014; 4:226-40. [PMID: 25755565 PMCID: PMC4284203 DOI: 10.1016/j.jceh.2014.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rapid point-of-care tests provide plausible diagnostic strategy for hepatitis B surface antigen (HBsAg) in low resource areas. However, their utility depends upon their overall performance. Our objective was to meta-analyze the diagnostic accuracy of rapid point-of-care tests for HBsAg. METHODS Literature search was done with the help of a metasearch engine Mettā, a query interface for retrieving articles from five leading medical databases. Studies that employed rapid point-of-care tests for detection of HBsAg and compared the results with reference test were included. Two reviewers performed quality assessment of the studies and extracted data for estimating test accuracy. Twenty-seven studies were meta-analyzed and stratified by multiple parameters. RESULTS Twenty-seven studies had evaluated 49 test brands and generated 76 data points. Sensitivity of individual tests varied widely and were heterogeneous (range 43.5%-99.8%); while specificity estimates were more robust and close to 100% (range 90%-100%). Overall pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio for all tests were 97.1% (95% CI, 96.1%-97.9%), 99.9% (CI, 99.8%-100%), 118.4 (CI, 84.7-165.5), 0.032 (CI, 0.023-0.045) and 4094.7 (CI, 2504.1-6600.8) respectively. This suggested high pooled accuracy for all studies. We found substantial heterogeneity between studies. Three factors (study location, reference standard and study score) appeared most strongly associated with test estimates and observed heterogeneity. The Determine test showed consistency in performance in studies done across developed and developing countries and the Determine and the BinaxNOW tests had significantly higher estimates than pooled estimates of remaining tests. Tests revealed analytical sensitivity of 4 IU/ml against manufacturer's claim of 0.5 IU/ml; reduced sensitivity with HBsAg mutants and poor performance in seroconversion panels. CONCLUSIONS Tests with better analytical sensitivity need to be developed and their feasibility and outcomes in various clinical settings need to be addressed.
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Key Words
- DOR, diagnostic odds ratio
- EIA, enzyme immunoassay
- ELISA, enzyme-linked immunosorbent assay
- HBsAg
- HBsAg, hepatitis B surface antigen
- HSROC, hierarchical summary receiver operating characteristic
- LR, likelihood ratio
- MEIA, micro-particle enzyme immunoassay
- PCR, polymerase chain reaction
- PRISMA, preferred reporting items for systematic reviews and meta-analysis
- QUADAS, quality assessment of diagnostic accuracy of studies
- RPOCTs, rapid point-of-care tests
- SROC, summary receiver operating characteristic
- STARD, standard for reporting diagnostic accuracy studies
- meta-analysis
- performance evaluation
- rapid test
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Affiliation(s)
- Mehnaaz S. Khuroo
- Government Medical College Srinagar, Kashmir, Jammu & Kashmir 190010, India
| | - Naira S. Khuroo
- Digestive Diseases Centre, Dr Khuroo Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India
| | - Mohammad S. Khuroo
- Digestive Diseases Centre, Dr Khuroo Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India,Address for correspondence. Mohammad S. Khuroo, Director, Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India. Tel.: +91 194 2491190, +91 9906591044 (mobile).
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El-Ghitany EM, Farghaly AG. Evaluation of commercialized rapid diagnostic testing for some Hepatitis B biomarkers in an area of intermediate endemicity. J Virol Methods 2013; 194:190-3. [PMID: 24004823 DOI: 10.1016/j.jviromet.2013.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 12/17/2022]
Abstract
Hepatitis B virus (HBV) is a major public health threat. Enzyme immune assay (EIA) of HBsAg is the screening method used in most settings, including in blood banks. Other markers are used to evaluate the HBV replication, immunity and the infectious level of the patient. Testing negative for HBsAg, however, does not always mean the absence of infection, and testing other markers using EIA is costly. This study evaluated the diagnostic reliability of commercially available non-HBsAg HBV biomarkers to detect their usefulness to screen for HBV infection. INTEC rapid tests for HBV markers were evaluated in 508 HBsAg negative blood donors and were compared to EIA as a reference method. Only anti-HBs, anti-HBc and anti-HBe could be evaluated. Sensitivities of all tests (64.2, 85.48, and 82.78 respectively) were much lower than those claimed by the manufacturer. The specificities and negative predictive values for all tests exceeded 95% and 93% respectively and were lowest for anti-HBs. Anti-HBe had the highest accuracy (99.02%), while anti-HBs had the lowest (90.16%). It was concluded that the rapid test performance was lower than the manufacturer's reports. They are reliable tools to prove negativity, but less efficient to confirm reactivity. The best performance was for anti-HBe. The positive results of anti-HBs was significantly associated with higher ELISA titer levels, which is therefore recommended to be used for screening of immunity.
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Yoo SJ, Sohn YH, Choi SE, Oh HB. [Meta-analysis for the pooled sensitivity and specificity of anti-human immunodeficiency virus Ab rapid tests]. Korean J Lab Med 2009; 29:345-52. [PMID: 19726898 DOI: 10.3343/kjlm.2009.29.4.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many immunochromatography (ICA) kits for anti-human immunodeficiency virus type (HIV) antibody (Ab) have been introduced to improve the accessibility of HIV Ab tests. However, qualified evaluation reports for HIV rapid tests are not enough to validate their performances. Meta-analysis for the performances of the HIV Ab rapid tests was performed in this study. METHODS PubMed database was searched with combination of search terms, 'human immunodeficiency virus', 'HIV Ab', 'rapid test', 'immunochromatography', 'performance', 'sensitivity', and 'specificity'. Criteria of inclusion were performance studies for HIV ICA kits with serum or EDTA whole blood. Methodological qualities were evaluated with standards for reporting of diagnostic accuracy studies (STARD) checklists by two investigators. Homogeneity among selected studies was evaluated and then pooled sensitivity and specificity were calculated. Positive and negative predictive values were simulated with presumed HIV prevalence in Korea. RESULTS Twenty-three studies were selected from 12 high-qualified papers with STARD checklists. The performance of 23 studies were found to be heterogeneous (P<0.1) and random effect model was used. Pooled sensitivity was 99.71% (95% CI: 99.45-99.97%) and pooled specificity was 99.27% (95% CI: 98.83-99.70%). With HIV prevalence of 0.03%, positive and negative predictive values were presumed to be 3.936% and 99.999%, respectively. CONCLUSIONS This meta-analysis for HIV ICA rapid tests showed good performance. In consideration of low positive predictive values of HIV rapid tests, confirmation by enzyme immunoassay or Western blot is still needed. This study would be helpful in evaluating and establishing proper performance guideline for those kits not fully evaluated.
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Affiliation(s)
- Soo Jin Yoo
- Department of Laboratory Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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An Overview of Meta-analyses of Diagnostic Tests in Infectious Diseases. Infect Dis Clin North Am 2009; 23:225-67, Table of Contents. [DOI: 10.1016/j.idc.2009.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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