Abstract
Background Human resources for health-care delivery are essential for attaining global health and development goals. Especially in developing countries, health extension workers are frontline health personnel who can play a key role in preventing and controlling HIV/AIDS. This study aimed to evaluate the performance of health extension workers in HIV-1/2 screening tests. Methodology. A comparative cross-sectional study was carried out to evaluate the performance of health extension workers in HIV-1/2 screening tests. Study participants had performed HIV screening tests on the prepared sample panels. Finally, the percentage of accuracy, error rate, sensitivity, specificity, predictive values, and measure of agreement (kappa) were calculated using SPSS version 26. Result Totally, 1600 HIV screening tests were performed, and of these, 684 and 235 tests were done by HEWs (n = 15) and laboratory personnel (n = 5), respectively, with three discordant results by HEWs from a single sample panel which was weak reactive for HIV antibody test. The sensitivity, specificity, PPV, and NPV of HIV screening tests by HEWs were 97.4%, 100%, 100%, and 97.22%, respectively, and 100% for all parameters when it is tested by laboratory professionals. The measure of kappa agreement was 0.971 (95% CI, 0.932–1) for HEWs and 1 for laboratory personnel compared with the reference result. Conclusion Based on this evidence, we conclude that the potential contribution of HEWs can be invaluable in the expansion of HIV screening tests nationwide to compensate the shortage of laboratory personnel.
Highlights
Human resources for health-care delivery are essential for attaining global health and development goals [1, 2]. ere is a strong correlation between the density of the health workforce, service coverage, and positive health outcomes, and a shortage of health workers has been widely and consistently identified as a barrier to the delivery of health services [1,2,3,4]. e Human immunodeficiency virus (HIV) pandemic has increased the demand of health workers, and at the same time, the increased global commitment to HIV puts more pressure on bottlenecks created by health workforce shortages [5]
To cope with the existing needs, nonlaboratory personnel should be participated in performing HIV screening tests [18]. erefore, this study aimed to evaluate the performance of HIV screening tests by health extension workers in comparison with laboratory personnel
All HIV screening tests done by health extension workers, and skilled laboratory personnel were evaluated against the reference result which was confirmed by fourth-generation ELISA, Murex HIV Ag/Ab Combination (Bio Murex, UK). e performance of laboratory personnel was 100% for all parameters, while the performance of health extension workers was calculated, and the sensitivity, specificity, positive predictive value, and negative predictive were 97.4%, 100%, 100%, and 97.2%, respectively, for all sample panels (Table 2). e kappa agreement of Health extension workers (HEWs) with laboratory personnel and reference result is 0.97(95% CI, 0.9–1) which shows a perfect agreement (Table 2)
Summary
Human resources for health-care delivery are essential for attaining global health and development goals. In developing countries, health extension workers are frontline health personnel who can play a key role in preventing and controlling HIV/AIDS. Is study aimed to evaluate the performance of health extension workers in HIV-1/2 screening tests. A comparative cross-sectional study was carried out to evaluate the performance of health extension workers in HIV-1/2 screening tests. Erefore, HEWs are frontline health personnel who can play a key role in increasing HIV/AIDS diagnostic services in the community [8, 9]. Erefore, HIV prevention and control programs that aim in helping more people should consider home-based VCT services, especially in resource-limited settings where transport to a clinic and confidentiality are considerable barriers to access the service [15,16,17] Different research studies showed that transport costs are often a barrier to access VCT. erefore, HIV prevention and control programs that aim in helping more people should consider home-based VCT services, especially in resource-limited settings where transport to a clinic and confidentiality are considerable barriers to access the service [15,16,17]
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