Bayesian inference for prevalence and diagnostic test accuracy based on dual-pooled screening

We propose a useful protocol for the problem of screening populations for low-prevalence characteristics such as HIV or drugs. Current HIV screening of blood that has been donated for transfusion involves the testing of individual blood units with an inexpensive enzyme-linked immunosorbent assay test and follow-up with a more accurate and more expensive western blot test for only those units that tested positive. Our cost-effective pooling strategy would enhance current methods by making it possible to accurately estimate the sensitivity and specificity of the initial screening test, and the proportion of defective units that have passed through the system. We also provide a method of estimating the distribution of prevalences for the characteristic throughout the population or subpopulations of interest.