Roman Shrestha

HIV recency testing is an innovative approach integrated into routine HIV surveillance to strengthen HIV programs across the globe. This session explored HIV recency testing, viral sequencing, and phylogenetics to shed light on demographic and geographic patterns of HIV transmission in various countries in Africa and Southeast Asia, and Canada.

Ha Truong reported global progress in implementing recent HIV infection surveillance using rapid tests in 13 PEPFAR-supported countries between October 2019 to June 2021. Despite a brief decrease in RTRI coverage during the start of the pandemic due to various factors (e.g., COVID-19 mitigation efforts, disruptions in HIV and VL testing, and PEPFAR guidance to temporarily pause recent infection testing), overall coverage increased during the reporting period. Suchunya Aungkulanon provided an overview of the integrated HIV recent infection testing into routine HIV testing services in 16 facilities in Bangkok, Thailand. Recent HIV infections were identified across all age groups, sexes, and populations, although a small proportion of RTRI-recent cases required reclassification when verified using a nationwide electronic ART registry. Dr. Chaudron highlighted the utility of a low-cost rapid, integrated method to monitor HIV VL, drug resistance, and transmission patterns from finger-prick blood samples. The findings demonstrated that this newly developed combined sequence-based assay accurately measured HIV VL, characterized drug resistance, and is currently being implemented in Zambia. Using a large provincial repository of HIV-1 datasets, Dr. Brenner observed a marked decline in subtype B epidemics among key populations from 2014 to 2020, concomitant to advances in PrEP and TaSP paradigms.

There is a critical need to scale-up low-cost, real-time surveillance tools to identify recently acquired HIV infection, monitor VL and drug resistance, and better characterize HIV transmission patterns. These tools will facilitate tailoring HIV prevention/treatment measures to key vulnerable populations in a timely and effective fashion. However, it is equally essential to consider ethical implications and community engagement during the development and implementation phases to ensure that the vulnerable groups benefit from these innovative technologies.