HIV screening Ministry of Public Health Launches a Three-test Algorithm

The Minister of Public Health, Dr Manaouda Malachie, made the announcement at a press briefing on Tuesday, July 9, 2024, at the Public Health Emergency Operations Coordination Center (PHEOCC)  in Yaoundé.

The transition to 3 tests represents a real step forward for Cameroon; it reinforces the results obtained with the 2-test algorithm to continue to reduce HIV prevalence in the general population and move towards the desired elimination by 2030.

The introduction of this new measure follows the fall in HIV prevalence in Cameroon to less than 5% in the general population.

The commitment made by Cameroon in 2015 to identify 90% of people infected with HIV, to put 90% of them on antiretroviral treatment and to achieve viral suppression in 90% of people on treatment, is fully in line with government’s vision, which is part of the transition from the three-test HIV screening algorithm in Cameroon.

The Minister of Public Health, Dr Manaouda Malachie, gave a press briefing on July 09, 2024, in the conference room the Public Health Emergency Operations Coordination Center (PHEOCC) in Yaoundé, on the transition to the three-test HIV screening algorithm in Cameroon.

According to the Minister of Public Health, this is a significant and decisive step forward in  joint efforts to improve the accuracy and effectiveness of screening in Cameroon, with the knowledge that this  step is even more important in the fight against HIV, and in particular, the march towards its elimination. Moreover, the World Health Organisation (WHO) is encouraging countries that still use two consecutive reactive tests to diagnose HIV-positive status to use three consecutive reactive tests to make such a diagnosis.

As a matter of fact, the introduction of this new system follows the fall in HIV prevalence in our country, to less than 5% in the general population. This means that the positive value of over 99% can be maintained for all HIV-positive results. The transition to 3 tests represents a real step forward for Cameroon; it reinforces the results obtained with the 2-test algorithm to continue to reduce HIV prevalence in the general population and move towards the desired elimination by 2030. For the general population: 1st test: First Response HIVl-2.O Card Test; 2nd test: One Step Anti-HIV (1&2) Test and the 3rd test Diagnostic kid for VIH (1+2) antibody (colloidal gold) V2 KHB. For antenatal and postnatal clinics: 1st test: First Response HIVl +2/Syphilis combo card test; 2nd test: One Step Anti-HIV (1&2) Test and the 3rd test Diagnostic kid for VIH (1 + 2) antibody (colloidal gold) V2 KH B. The probability that a sample falsely reactive with the first test (T1) is not also falsely reactive with the second test (T2) and the third test (T3).

It is suggested that a study be carried out to verify the new screening algorithms, with the following aims: Identify the combination of products that presents the least possible shared false reactivity in order to reduce the risk of false positive diagnosis. This is in order to minimise shared cross-reactivity. Products from the same manufacturer should not be used in the screening algorithm. This will involve first-line use of the combined HIV-Syphilis test and the rapid hepatitis B test. The first stage will be to implement the new algorithm in 4 regions of Cameroon: Centre, South, Littoral and West for a period of 3 months. The choice of these 4 regions reflects both their epidemiological profile and population density, as well as the structuring elements within the activities implementing these public policies.

In the second stage, the approach will be extended to the other 6 regions and will involve a pre-selection of health facilities over a period of 3 months. It should be noted that this first phase will mainly concern pregnant women and key populations. This is one of the priorities of Universal Health Coverage, phase 1, which also covers care for people with HIV-AIDS, as well as care for pregnant women. During the second phase, which will begin in 2025, the strategy provides for the gradual enrolment of health facilities throughout the country, as well as the general population.

During the first phase in these regions, the other facilities will continue to apply the 2-test algorithm, thus ensuring continuity of screening for HIV-AIDS treatment in our health facilities. This transition will be methodical, with capacity-building for all those involved, in order to capitalise on all the strengths and opportunities offered by this new approach.

The overall prevalence of HIV in the population was halved between 2004, when it was 5.4%, and 2018, when it was 2.7%, according to data from the 2018 demographic and health survey. I’m convinced that this rate has improved even further since then. In absolute terms, the number of new infections per year has risen from 458,35 in 2004 to 9898 in 2022.

The number of HIV-AIDS-related deaths is estimated to have fallen from 31,444 to 1,0198 over the same period. These developments may seem improved, but the fight continues. As a first step, it aims to reduce the still very high prevalence among women (3.4%) compared to men (1.9%), and the rate of new infections among exposed children, adolescents, young people and key populations classified as high-risk.

Elvis Serge NSAA