What is the overall goal of this strategic approach?

The primary objective of this surveillance system is to monitor recent infections among newly diagnosed PLHIV and identify, in real-time, geographic areas with high probability of recent transmission. Identification and investigation of potential recent transmissions will enable the public health response to be efficient and targeted to those at highest risk of transmitting and acquiring HIV infection. At the population-level, data from the surveillance system will be used to monitor trends in recent infection among newly diagnosed PLHIV by person, place, and time to inform epidemic control efforts.

Three distinct use-cases for recency testing have been defined to date:

• Epidemiological/Surveillance – used in monitoring trends in new infections as a proxy for incident HIV infection. Typically test results are not returned to the client.
• Programmatic – used to assess geographic and sociodemographic trends of people diagnosed with recent infections among all new HIV infections for the purpose of informing program management to focus services, i.e. targeting HIV testing, prevention and treatment services.
• Individual – for use as a supplementary assay as an addition to the WHO recommended HIV testing strategies for diagnosis, e.g. as Assay 3. Test results are returned to the clients. PEPFAR is currently undertaking implementation of recency testing in various countries to evaluate the potential benefits and harms of recency tests and recent infection surveillance.