International Journal of STD & AIDS > Volume 20, Number 1 > Pp. 30-34

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Original research articles

Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala

M R Anderson MD ^* , B Samayoa QB   ^**, L F O'Sullivan PhD ^* , J Fletcher MA MS ^* and E Arathoon MD   ^**

^* Department of Family and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; University of New Brunswick, Fredericton, New Brunswick, Canada; Universidad Autónoma San Carlos de Guatemala; Asociación de Salud Integral (ASI); ^** Clínica Familiar Luis Ángel García (CFLAG), Guatemala

Correspondence to: Dr Matt R Anderson Email: bronxdoc{at}gmail.com

The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection.

Key Words: HIV infection • risk factors • adults • Guatemala

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