Dunning L., et al. PLoS Med 14 (2017), (11): e1002446. doi:10.1371/journal.pmed.1002446ZXY.
The specificity of nucleic acid amplification tests (NAATs) used for early infant diagnosis (EID) of HIV infection is <100%, leading some HIV-uninfected infants to be incorrectly identified as HIV-infected (false positive diagnoses). The World Health Organization recommends that infants undergo a second NAAT to confirm any positive test result, but implementation is limited. This study used a computer simulation model of pediatric HIV infection, diagnosis, and treatment to examine the clinical and economic outcomes of EID programs with and without confirmatory testing in South Africa. The authors conclude that confirmatory testing prevents inappropriate HIV diagnosis, is cost-saving, and should be adopted in all EID programs.