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Progress in scaling up HIV recent infection surveillance in 13 countries: October 1, 2019 - June 30, 2021

Title
Progress in scaling up HIV recent infection surveillance in 13 countries: October 1, 2019 - June 30, 2021
Presenter
Ha Truong
Authors
H. Truong * (1,2), M. Arons (1), M. Schmitz (3,4), M. Pasipamire (5), G. Abera (6), A. Haile (6), Y. Tedla (6), N. Farach (7), C. Gutierrez (7), N. Wadonda-Kabondo (8), D. Payne (8), A. Beukes (9), I. Pietersen (9), M. Alagi (10), G. Asalou (10), I. Kankindi (11), S. Malamba (11), C. Kittinunvorakoon (12), A. Mubiru (13), B.T.T. Hien (14), Q. Nguyen (14), P. Minchella (15), P. Chikwanda (16), E. Gonese (16), B. Moyo (16), S. Behel (1), E. Yufenyuy (1), S. Ahmed (1), N. Zender (17), H. Dale (1), P. Hosseini (17), O. Nzoutchoum (4,3), E. Sharp (4,3), B. Parekh (1), M. Martin (1), P. Monita (1)
Institutions
(1) Centers for Disease Control and Prevention, Atlanta, United States, (2) Public Health Institute/Centers for Disease Control, Global Health Fellowship Program, Atlanta, United States, (3) United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, United States, (4) Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States, (5) Centers for Disease Prevention and Control, Mbabane, Eswatini, (6) Centers for Disease Prevention and Control, Addis Ababa, Ethiopia, (7) Centers for Disease Control and Prevention, Guatemala City, Guatemala, (8) Centers for Disease Control and Prevention, Lilongwe, Malawi, (9) Centers for Disease Control and Prevention, Windhoek, Namibia, (10) Centers for Disease Control and Prevention, Abuja, Nigeria, (11) Centers for Disease Control and Prevention, Kigali, Rwanda, (12) Centers for Disease Control and Prevention, Bangkok, Thailand, (13) Centers for Disease Control and Prevention, Kampala, Guatemala, (14) Centers for Disease Control and Prevention, Hanoi, Viet Nam, (15) Centers for Disease Control and Prevention, Lusaka, Zambia, (16) Centers for Disease Control and Prevention, Harare, Zimbabwe, (17) Office of the U.S. Global AIDS Coordinator and Health Diplomacy, United States Department of State, Washington, D.C., United States

BACKGROUND: In 2018, countries supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) began implementing recent HIV infection surveillance among newly diagnosed people living with HIV (PLHIV) to provide signals of ongoing HIV transmission. Recent infection surveillance uses results from rapid tests for recent infection (RTRIs) with viral load results to improve accuracy as part of a recent infection testing algorithm (RITA). We assessed global progress in recent infection surveillance in PEPFAR-supported countries.
METHODS: We collected recency data for adults '¥15 years from October 1, 2019'June 30, 2021 and pooled results from 13 countries (Eswatini, Ethiopia, Guatemala, Malawi, Namibia, Nicaragua, Nigeria, Rwanda, Thailand, Uganda, Vietnam, Zambia, Zimbabwe). We described quarterly trends in RTRI site coverage (% of sites reporting '¥1 RTRI) and RTRI testing coverage (% of newly diagnosed PLHIV who had an RTRI). In a subset of seven countries (Eswatini, Nigeria, Rwanda, Thailand, Uganda, Vietnam, Zambia), we described trends in RITA site and testing coverage (% of sites and PLHIV reporting RITA results) for the October 1, 2019'June 30, 2021 study period.
RESULTS: Among the 13 countries, RTRI site coverage increased from 10.3% (733/7,107) to 21.5% (1,900/8,818) during the study period, and RTRI testing coverage increased from 9.0% (13,864/153,268) to 18.0% (41,688/231,410). During April 1'June 30, 2020, a quarter within the study period coinciding with the COVID-19 epidemic, RTRI site and testing coverage decreased 9.6% (22,437/234,164) to 3.2% (85,791/183,085). For the subset of seven countries, RITA site coverage decreased from 71.0% (88/124) to 48.1% (276/574) during the study period, and RITA testing coverage decreased from 70.2% (290/413) to 58.7% (1,651/2,814).
CONCLUSIONS: For the 13 countries, RTRI site and testing coverage increased during the study period but remained low. RTRI coverage decreased temporarily April 1'June 30, 2020. For the subset of seven countries, RITA site and testing coverage decreased during the study period. These decreases may be due to COVID-19 mitigation efforts, disruptions in HIV and viral load testing, and PEPFAR guidance to temporarily pause recent infection testing. Expanding access to recent infection testing can provide data for public health action to prevent new HIV infections.