A human immunodeficiency virus screening algorithm to address the high rate of false-positive results in pregnant women in Japan.

BACKGROUND: Prenatal human immunodeficiency virus (HIV) testing is essential for the prevention of mother-to-child transmission. However, false-positive results of screening testing are a concern as they may cause unnecessary emotional stress to pregnant women waiting for confirmatory test results. In regions with an extremely low prevalence, the positive predictive values of screening are unacceptably low rate. Here, we propose a HIV screening algorithm consisting of serial two fourth-generation enzyme immunoassays to reduce the number of false-positive screening results. METHODOLOGY/PRINCIPAL FINDINGS: When 6461 pregnant women presenting to two maternity hospitals located in the Tokyo metropolitan area of Japan from September, 2004 to January, 2006 were tested using Enzygnost HIV Integral as a first screening test, 27 showed positive reactions. When these positive reaction samples were tested using VIDAS HIV DUO Quick as a second screening test, only one of them had a positive reaction, and the remaining 26 were nonreactive. Confirmatory Western blots and nucleic acid amplification test also showed that one was positive and the remaining 26 were negative; the subject who was positive with the confirmatory tests was identical to the subject who was positive with the second screening test. Thus, by adding the second screening test, the false-positive rate was improved from 0.4% to 0%, and the positive predictive value from 3.7% to 100%, compared with the single screening test. CONCLUSION: By applying our serial screening algorithm to HIV testing in maternity hospitals, many uninfected pregnant women would not need to receive confirmatory tests and be subjected to emotional turmoil while waiting for their confirmatory test results. This algorithm would be suitable for HIV testing of pregnant women living in low prevalence regions such as Japan.

[Testing services for sexually transmitted infections in Japan, public funding for HIV testing compared to public funding for other STI testing].

HIV and other STIs testing services of public funded setting have not been integrated in Japan. Public health centers and other public funded testing sites provide free anonymous HIV test. This has been playing an important role to confirm almost half of asymptomatic patients. Early diagnosis is an essential intervention for personal health, and critical for preventative strategies of public health. However, the role of public health centers and other public funded testing sites are very limited for other STIs. The symptomatic patients visit private clinic/hospital for diagnosis and treatment, but it is difficult for asymptomatic person to visit such medical facilities. The prevalence of genital chlamydia in young women in Japan remains very high compared to other developed countries. So, I think public funding of testing for genital chlamydia and other asymptomatic STIs should be expanded and integrated with HIV testing programs in Japan. Recently, there is the problem of the shortage of OB/GY doctors and clinics. This might influence the accessibilities of STIs testing and treatment opportunities for women. This is a new problem of STI testing in Japan.