Diagnostic Accuracy of Urine and Oral Fluid Based Rapid Tests for HIV Infection: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.48048/tis.2026.13796Keywords:
HIV, Rapid diagnostic tests, Urine, Oral fluid, Diagnostic accuracy, Sensitivity, SpecificityAbstract
Human Immunodeficiency Virus (HIV) infection requires early detection to enable timely treatment and prevent transmission. Conventional HIV testing commonly relies on blood samples, which are invasive and may limit testing uptake in some populations. Non-invasive specimens such as urine and oral fluid have emerged as alternative samples that may improve the acceptability and accessibility of testing. This study aimed to evaluate the diagnostic accuracy of rapid HIV tests using urine and oral fluid specimens through a systematic review and meta-analysis. A comprehensive search of electronic databases identified studies evaluating the diagnostic performance of urine- and oral-fluid-based rapid HIV tests compared with reference standard methods. Eligible studies provided sufficient data to construct a 2×2 contingency tables. Pooled sensitivity and specificity were estimated, and summary receiver operating characteristic (SROC) curves were generated to assess overall diagnostic performance. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD420261321766). Forest plot analysis showed that urine-based rapid HIV tests had a pooled sensitivity of 0.96 (95% CI: 0.86 - 0.99) and specificity of 1.00 (95% CI: 1.00 - 1.00). Oral fluid-based tests demonstrated a pooled sensitivity of 0.98 (95% CI: 0.95 - 0.99) and specificity of 1.00 (95% CI: 1.00 - 1.00). Bivariate random effects analysis showed pooled sensitivity and specificity of 0.947 and 0.998 for urine-based tests and 0.959 and 0.996 for oral fluid-based tests, with SROC AUC values approaching 1.0. Meta-regression analysis suggested that specimen collection procedures and test brands contributed to heterogeneity among studies. These findings suggest that urine and oral fluid specimens show high diagnostic accuracy for HIV detection using rapid diagnostic tests and may support non-invasive HIV screening strategies.
HIGHLIGHTS
- Rapid HIV tests using urine and oral fluid showed high diagnostic accuracy.
- Oral fluid tests demonstrated high pooled sensitivity and specificity
- Urine-based tests showed comparable diagnostic performance.
- Meta-analysis confirmed minimal differences between specimen types.
- Non-invasive testing may expand HIV screening access
GRAPHICAL ABSTRACT
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