Recognition of AIDS by health personnel in rural South-Rwanda.

In order to test the ability of health care workers in rural Rwanda to recognize the signs and symptoms of AIDS according to the World Health Organization clinical case definition (CCD) and to the slightly modified Rwandan version serum samples and completed questionnaires were collected from all 4141 clinically-suspected cases of AIDS from 62 rural health centers and hospitals in Butare province during 1991. Of the 3669 patients older than 12 years 964 met the CCD for adults and 444 were seropositive. 1040 met the modified Rwandan version of the CCD and 482 were seropositive. Of the 472 children 35 met the CCD for children with 16 seropositive. 53 met the Rwandan CCD and 20 of these were seropositive. Sensitivities of the CCD and the Rwandan CCD respectively were 33 and 36% in adults and 13 and 16% in children. The respective specificities were 78 and 76% in adults and 94 and 90% in children. The positive predictive values were therefore 46% in adults and 44 and 38% respectively in children. These low sensitivity and positive predictive values will result in many cases of AIDS going undiagnosed. Whereas no single symptom had a sensitivity and specificity high enough to be used for diagnoses an episode of herpes zoster is highly indicative of AIDS. Since this diagnosis is unequivocal this strong association may prove useful in the diagnosis of AIDS. Because laboratory tests will remain unavailable in certain settings health personnel must receive proper training to improve their ability to diagnose AIDS following the clinical case definition.