Risk screening tools could potentially miss out HIV positive individuals who seek testing services: A secondary program data analysis on the performance characteristics of an adolescent and adult HIV risk screening tool in Uganda

Introduction Improving HIV testing efficiency has been documented to save financial and material resources for health. In October 2019, the Ministry of health Uganda deployed an HIV risk screening tool for use in 24 health facilities targeting clients aged 15 years and above in both outpatient and Voluntary Counselling and Testing departments. Methods We conducted a retrospective secondary data analysis of routinely collected HIV risk screening program data in Uganda, collected from October to November 2019, to determine the performance characteristics of the adolescent and adult HIV risk screening tool in public health facility settings. Statistical measures for the risk screening tool performance included sensitivity, specificity, positive and negative predictive values, and a cost analysis. Results A total of 19,854 clients were screened for HIV testing eligibility; we excluded 150 records with incomplete testing information. The overall positivity rate (cluster weighted prevalence of HIV) among those screened was 4.5% (95% CI: 4.1%-4.8%) versus 3.71% (95% CI: 3.06-4.50) among those not screened. The sensitivity and specificity of the risk screening tool were found to be 90.7% (95% CI: 88.4%, 92.7%) and 75.8%, (75.2-76.4) respectively. With screening, the number needed to test to identify one PLHIV reduced from 27 to 22. Although risk screening would have led to 24.5% (4,825/19,704) reduction in testing volume, 9.3% (68/732) of PLHIV would have been missed as they were misclassified as not eligible for testing. The cost per PLHIV identified fell by 3% from $69 without screening to $66.9 with implementation of the screening tool. Conclusions The use of HIV risk screening tool in OPD settings in Uganda demonstrated improved HIV testing efficiency by reducing testing volumes but resulted in screening out of a significant number of people living with HIV. The team recommends that scientifically validated HIV risk screening tools be considered for use by countries. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This was a secondary data analysis of program data I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying the results presented in the study are available from Ministry of Health Uganda, STD/AIDS Control Program upon request via joshuamusinguzi{at}yahoo.co.uk