Healthcare providers’ knowledge of, attitudes towards, and experience with HIV-1 recency testing and index testing in Rwanda, July–December 2021 (INTEREST 2022).
Rwanda has implemented recency testing and partner/index HIV testing since 2018 as part of a national case-based surveillance (CBS) program. As of April 2022, 584 health centers have been trained and activated to conduct recency testing and partner/index HIV testing in all five provinces in Rwanda. Index clients are screened for intimate partner violence (IPV) as part of partner/index HIV testing. Preliminary, unpublished data from an ongoing study in Rwanda suggest that at least 30% of index clients have experienced any IPV in the past four weeks.
Correlates of recent infection among persons newly diagnosed with HIV in Nigeria, March 2020–September 2021 (INTEREST 2022).
In 2020, Nigeria implemented a HIV-1 recent infection surveillance program to identify sub-populations where transmission may be high to accelerate progress towards epidemic control. We examined correlates of recent infection to identify characteristics that can help inform where and among whom case finding and prevention efforts should be intensified.
Trends in recent HIV-1 infection among new diagnoses in Eswatini and Rwanda, 2019-2021 (INTEREST 2022).
As countries progress towards achieving 95% of people living with HIV (PLHIV) aware of their HIV status, new PLHIV diagnoses should comprise more recent and fewer long-term infections. We assessed trends in the proportion of recent HIV infections over time in Eswatini and Rwanda, where 87% (SHIMS2 2016–2017) and 83% (RPHIA 2018–2019) of HIV positive adults know their status, respectively.
Acceptability and feasibility of HIV recent infection surveillance by healthcare workers using a rapid test for recent infection at HIV testing sites — Malawi, 2019 (March 2022).
The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities. At 23 health facilities in Blantyre District, healthcare workers (HCWs) were trained to conduct recent infection testing. In September 2019, we conducted a cross-sectional survey at these sites to explore the acceptability and feasibility of integrating this activity into routine HIV testing services (HTS). Research assistants interviewed HCWs using a semi-structured survey. Descriptive statistics were used to summarize quantitative responses and thematic analysis was used to group open-ended text.
Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019-March 2020 (MMWR March 2022).
A novel HIV infection surveillance initiative was implemented in Malawi to collect data on recent HIV infections among new diagnoses to characterize the epidemic and guide the public health response. Higher proportions of recent infections were identified among females, persons aged <30 years, and clients at maternal and child health and youth clinics. Spatial analysis identified three hotspots of health facilities with significantly higher rates of recent infection than expected across five districts. Geospatial analysis of recent HIV infection surveillance data can identify potential transmission hotspots. This information could be used to tailor program activities to strengthen HIV testing, prevention, and treatment services and ultimately interrupt transmission.
Detecting Recent HIV Infections in Outpatient Departments: A Multi-Country Analysis (CROI February 2022).
Diagnosing all persons living with HIV (PLHIV) as early as possible after infection is critical to reach and sustain HIV epidemic control. The U.S President’s Emergency Plan for AIDS Relief has prioritized index testing over testing in outpatient departments (OPD) as the most efficient means to locate PLHIV. HIV recent infection surveillance using recent infection testing algorithms (RITA) in routine HIV testing services (HTS) can help identify which testing approaches are effective at identifying PLHIV earlier to inform their public health response.
Experiences and lessons learned from the real-world implementation of an HIV recent infPerformance of a novel rapid test for recent HIV infection among newly-diagnosed pregnant adolescent girls and young women in four high-HIV-prevalence districts—Malawi, 2017–2018 (February 2022).
Tests for recent HIV infection (TRI) distinguish recent from long-term HIV infections using markers of antibody maturation. We conducted a field-based laboratory evaluation of the RTRI among pregnant adolescent girls and young women (AGYW) attending antenatal clinics (ANC) in Malawi. This was the first field evaluation of an RTRI in sub-Saharan Africa, which demonstrated good performance of the assay and feasibility of integrating RTRI into routine HIV testing services for real-time surveillance of recent HIV infection.
Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018-2020 (November 2021).
Despite Rwanda’s progress toward HIV epidemic control, 16.2% of HIV-positive individuals are unaware of their HIV positive status. Tailoring the public health strategy could help reach these individuals with new HIV infection and achieve epidemic control. Recency test- ing is primarily for surveillance, monitoring, and evaluation but it’s not for diagnostic pur- poses. However, it’s important to know what proportion of the newly diagnosed are recent infections so that HIV prevention can be tailored to the profile of people who are recently infected. We therefore used available national data to characterize individuals with recent HIV infection in Rwanda to inform the epidemic response.
Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe (2021).
Testing for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings.
Can HIV recent infection surveillance help us better understand where primary prevention efforts should be targeted? Results of three pilots integrating a recent infection testing algorithm into routine programme activities in Kenya and Zimbabwe (April 2020)
The MESH consortium conducted three pilot studies to assess the feasibility and utility of recent infection testing in Kenya and Zimbabwe. The results of those pilots suggest that recent infection surveillance, when rolled-out nationally, may help in further targeting primary prevention efforts.
Recent HIV Infection Surveillance in Routine HIV Testing in Nairobi, Kenya: A Feasibility Study (May 2020)
The MESH consortium with UCSF and the Eastern Deanery AIDS Relief Program (EDARP) conducted a feasibility assessment of integration recent infection testing into routine HIV counseling and testing at selected sites in Nairobi Kenya. The results found that integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level.
HIV recency testing: should results be disclosed to individuals tested? (June 2020)
An expert panel was assembled by the PEPFAR scientific advisory board to assess the ethical and safety considerations related to returning recent infection test results to individuals.
MeSH Consortium Report on the feasibility and utility of HIV recent infection testing in a range of routine service provision contexts (July 2019)
Distinguishing recently acquired infection from “long-standing” infection among persons newly diagnosed with HIV can help identify populations and geographic areas where current transmission is occurring; crucial information to inform programme planning. Given this, we set out to assess the feasibility and utility of various approaches to conducting HIV recent infection testing in a range of routine service-provision contexts; namely, in antenatal clinics providing PMTCT services (Siaya County, Kenya), routine HIV testing and counselling clinics (Nairobi, Kenya), and a programme for female sex workers (Zimbabwe).
Tracking with recency assays to control the epidemic: real-time HIV surveillance and public health response (July 2019)
With new developments in laboratory technology, rapid detection of recent HIV infection (i.e. HIV-antibody seroconversion occurring on average in the past 6 months) is now possible using a validated rapid test for recent infection (RTRI) that diagnoses HIV and detects recent infection within minutes [4–6]. The RTRI allows person, place, and time to be described for all new HIV diagnoses at the point of HIV testing services (HTS), forming the basis of a real-time surveillance and public health response system that accelerates the surveillance to care continuum. As the system generates routine information on trends in new diagnoses, it can simultaneously provide signals at the most granular level to inform programs where to focus interventions to reach those that need them the most.
Estimating HIV Incidence and Detecting Recent Infection among Pregnant Adolescent Girls and Young Women in Malawi – Working Together for an AIDS-free Future for Girls and Women (October 2019)
The Malawi Ministry of Health (MOH) and its partners implemented a novel surveillance system to detect and characterize recent HIV infections and estimate HIV incidence among adolescent girls and young women (AGYW) receiving antenatal care (ANC) in four high-prevalence districts of Malawi. A description of the methods and key findings from the pilot implementation of this surveillance system – which was called the Malawi Recency Study.
Performance of a novel point-of-care test for recent HIV infection among newly diagnosed pregnant adolescent girls and young women in 4 high HIV prevalence districts – Malawi (2017-2018)
The MESH consortium conducted three pilot studies to assess the feasibility and utility of recent infection testing in Kenya and Zimbabwe. The results of those pilots suggest that recent infection surveillance, when rolled-out nationally, may help in further targeting primary prevention efforts.
Performance Evaluation of Asante™ Rapid Recency Assay for HIV Diagnosis and Detection of Recent Infection: Potential for Surveillance and Prevention (2017).
Detection of recent infection is critical for incidence estimates from surveys and can also help in targeted prevention. We previously described development of a rapid test that can diagnose HIV infection and detect recency of infection in one device. This technology was successfully transferred to a commercial partner as AsanteTM Rapid Recency Assay developed by Sedia BioSciences (Portland, OR). We evaluated performance of this assay in laboratory using a well-characterized panel of specimens.
Development of a Novel Rapid HIV Test for Simultaneous Detection of Recent or Long-Term HIV Type 1 Infection Using a Single Testing Device (2013)
Laboratory assays for the detection of recent HIV infection for HIV incidence surveillance are essential to HIV prevention efforts worldwide because they can identify populations with a high incidence and allow targeting of resources and monitoring of incidence trends over time. This study describes the development of a novel rapid HIV-1 incidence-prevalence (I-P) test that can be used for the simultaneous detection and discrimination of prevalent (long-term) or incident (recent) HIV infections using a single device.
