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WHO Prequalification of In Vitro Diagnostics Programme PUBLIC REPORT Product: Uni-Gold HIV Number: PQDx 0149-052-00 Abstract Uni-Gold HIV with product codes 1206502, 1206502N, 1206502E, 1206502N-100 manufactured by Trinity Biotech Manufacturing Ltd., rest of the world regulatory version, was accepted for the WHO list of prequalified diagnostics and was listed on 20 December 2012. This public report was updated on 28 February 2017, 26 July 2017, 06 November 2017, and 20 December 2018 to reflect recent changes. Summary of WHO prequalification assessment for Uni-Gold HIV Date Outcome PQ public report amended 20 December 2018 accepted 03 November 2017 26 July 2017 28 February 2017 12 August 2016 PQ listing 20 December 2012 listed Dossier review 03 December 2012 MR Site inspection(s) of quality 18-20 July 2016 (Supplier) MR management systems 11-14 September 2012 (Supplier) 29-31 August 2012 (Ireland) Laboratory evaluation of performance 17 December 2012 MR and operational characteristics MR: Meets Requirements Intended use: Uni-Gold HIV is a single use rapid immunoassay, for the qualitative detection of antibodies to HIV-1 and HIV-2 in serum, plasma and whole blood (venous and fingerstick). Uni-Gold HIV is intended for use in point of care settings as an aid in diagnosis of HIV-1 and HIV-2 infection. Assay description: Uni-Gold HIV is a rapid immunoassay based on the immunochromatographic sandwich principle. Recombinant proteins representing the immunodominant regions of the envelope proteins of HIV-1 and HIV-2, glycoprotein gp41, gp120 (HIV-1) and glycoprotein gp36 (HIV-2) respectively, are immobilized at the test region of the nitrocellulose strip. These proteins are also linked to colloidal gold and impregnated below the test region of the device. A narrow band of the nitrocellulose membrane is also sensitized as a control region.

During testing two drops of serum, plasma or whole blood is applied to the sample port, followed by two drops of Wash Solution and allowed to react. Antibodies of any immunoglobulin class, specific to the recombinant HIV-1 or HIV-2 proteins, will react with the colloidal gold linked antigens. The antibody protein colloidal gold complex moves chromatographically along the membrane to the test and control regions of the test device. Excess conjugate forms a second pink/red line in the control region of the device. appearance of this band indicates proper performance of the reagents in the kit. The Test kit components: Component Test Devices Individually pouched plastic cassettes Wash Solution 2.0 ml of Wash Solution contains Tris buffer, Borate buffer, Chaotropic agent, Surfactant, Polyether compound, Sugar, Polymer and the preservative ProClin 300 at 0.06 v/v. Disposable Pipettes 20 plastic, non-sterile, units in a ziplock bag, pipette length 130 ± 2 mm, drop volume 25µl 35µl. 20 tests (product codes 1206502, 1206502N, 1206502E) 20 100 100 tests (product 1206502N-100) 1 vial (2 ml) 5 vials (2 ml) 20 100 Instructions for use 1 5 Other materials required but not provided: Item Consumables: Blood collection devices for venous blood collection Lancet of depth 1.5-2.0 mm that is capable of producing 60µl whole blood droplet Sterile wipes, sterile gauze pads, adhesive bandages Biosafety waste disposal container Durables: N/A Equipment: Timer or stopwatch Personal protective equipment

Storage: The test kit should be stored at 2 to 27 C. Shelf-life upon manufacture: 20 months. Warnings/limitations: See manufacturer s instructions for use.

Prioritization for prequalification Based on the established criteria, Uni-Gold HIV was given priority for WHO prequalification. Product dossier assessment Trinity Biotech Manufacturing Ltd. submitted a product dossier for Uni-Gold HIV as per the Instructions for compilation of a product dossier (PQDx_018 v1). The information (data and documentation) submitted in the product dossier was reviewed by WHO staff and external technical experts (assessors) appointed by WHO. The manufacturer's responses to the nonconformities found during dossier screening and assessment findings were accepted on 4 December 2012. Commitments for prequalification: The manufacturer committed to amend and submit additional documentation on the following issues: 1. Analytical performance studies 2. Clinical performance studies 3. Shipping stability studies 4. A new version of the instructions for use. WHO will to follow-up on implementation of these commitments at the next re-inspection. Based on the product dossier screening and assessment findings, the product dossier for Uni- Gold meets WHO prequalification requirements. Manufacturing site inspection A comprehensive inspection was performed at the site of the legal manufacturer between 1-3 March 2016 and at the site of a key supplier between 18-20 July 2016, as per Information for manufacturers on prequalification inspection procedures for the sites of manufacture of diagnostics. (PQDx_014). The inspection found that the manufacturer had an acceptable quality management system and good manufacturing practices in place that ensured the consistent manufacture of a product of good quality. The manufacturer's responses to the nonconformities found at the time of the inspection were accepted on 3 May 2016 and 11 November 2016, respectively. Based on the site inspection and corrective action plan review, the quality management system for Uni-Gold meets WHO prequalification requirements.

Laboratory evaluation Uni-Gold TM HIV was evaluated by WHO in the third quarter of 2012 at the Institute of Tropical Medicine, Antwerp, Belgium a WHO Collaborating Centre for HIV-AIDS Diagnostics and Laboratory Support. The laboratory evaluation was conducted according to the WHO Protocol for the laboratory evaluation of HIV serology assays (PQDx_030 V1.0), and drew the following conclusions: Uni-Gold TM HIV is an immunochromatographic rapid diagnostic test for the detection of HIV-1/2 antibodies in human serum, plasma and whole blood. A volume of 60 µl of specimen is needed to perform the assay. This type of assay requires no sophisticated equipment and can therefore be performed in laboratories with limited facilities and non-laboratory settings. Reading of the results can be done visually i.e. subjectively read. In this limited performance evaluation using a panel of 1079 clinically-derived specimens, we found an initial sensitivity (95% CI) of 99.76% (98.7%-100%) and an initial specificity (95% CI) of 99.85% (99.2%-100%) compared to the reference assays. The final sensitivity (95% CI) was 99.76% (98.7%-100%) and the final specificity (95% CI) was 99.85% (99.2%-100%) compared to the reference assays. Lot to lot variation was acceptable. In this study, 0% of the results were recorded as indeterminate. Results were interpreted independently by three technicians; the inter-reader variability was 0.09%. The invalid rate was 0.09%. For eight seroconversion panels, Uni-Gold TM HIV detected on average 0.125 specimens later than the benchmark assay; Enzygnost Anti-HIV 1/2 Plus (Siemens Healthcare Diagnostics). For the mixed titer panel, Uni-Gold TM HIV correctly classified all specimens. Four out of the six anti- HIV indeterminate/hiv-1 antigen positive specimens were identified as anti-hiv-1/2 reactive. For the 1 st International Reference Panel for anti-hiv [NIBSC code 02/210], Uni-Gold TM HIV correctly classified all specimens with the exception of subtype O. Change notification Trinity Biotech Manufacturing Ltd., has submitted a number of change notifications related to: 1. Changes in packaging (2013). 2. Changes in instructions for use (2014). 3. Changes in labelling (2015). 4. Change in manufacturing processes (2015). 5. Change in desiccant (2016). 6. Change in wash solution (2016). 7. Change in labelling for one specific market (2016). 8. Update to Instructions for Use (2017). 9. Addition of new packaging configuration for the Nigerian market (2017). These change notifications were assessed and the product was found to meet WHO prequalification requirements.

Labelling 1. Labels 2. Instructions for use

1. Kit box/laser etching/pouch/label (wash buffer) Kit Box P/N 1206502

Kit Box P/N 1206502N-100

Laser etch details for outer kit box (left side of box) Laser etch 1206502 Laser etch for 1206502N Laser etch for 1206502E Laser etch 1206502N-100

Pouch - Test Device The test device pouch is overprinted with the reference number (1206502) and lot number (e.g. HIV1234 567), expiry (e.g. 31 DEC 17)

Label (wash bottle)

2. Instructions for Use for kit P/N 1206502

Instructions for Use for kit P/N 1206502N-100