Brief Report: Recent HIV Infection Surveillance in Routine HIV Testing in Nairobi, Kenya: A Feasibility Study

Welty, Susie; Motoku, John; Muriithi, C; Rice, Brian; Wit, Mariken de; Ashanda, Brenda; Waruiru, Wanjiru; Mirjahangir, Joy; Kingwara, Leonard; Bauer, Richard L.; Njoroge, David; Karimi, Jesse; Njoroge, Alice; Rutherford, George W

doi:10.1097/qai.0000000000002317

Cited by 16 publications

(26 citation statements)

References 15 publications

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“…Our finding that women represent 70% of the total HIV recent infections compared to men supports other reported data [ 18 ]. This finding might be explained by gender discrepancies in seeking healthcare services, by women’s higher HIV acquisition risk, or imbalances in power in negotiating for safe sex.…”

Section: Discussionsupporting

confidence: 93%

“…The odds of testing recent was lower among those aged ≥25 years compared to those aged 15–24 years. Similar findings have been reported in other studies where young women have the most recent infections [ 18 ]. In the 2018 Rwanda Population-Based HIV Impact Assessment (RPHIA) survey, young women aged 20–24 years had the highest HIV prevalence, which was 3 times higher than men of the same age; the HIV prevalence was higher in men aged ≥50 years than in women of the same age group [ 9 ].…”

Section: Discussionsupporting

confidence: 92%

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Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018–2020

Rwibasira¹,

Malamba

Musengimana

et al. 2021

PLoS ONE

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Background 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 testing is primarily for surveillance, monitoring, and evaluation but it’s not for diagnostic purposes. 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. Methods We included all national-level data for recency testing reported from October 2018 to June 2020. Eligible participants were adults (aged ≥15 years) who had a new HIV diagnosis, who self-reported being antiretroviral therapy (ART) naïve, and who had consented to recency testing. Numbers and proportions of recent HIV infections were estimated, and precision around these estimates was calculated with 95% confidence intervals (CI). Logistic regression was used to assess factors associated with being recently (within 12 months) infected with HIV. Results Of 7,785 eligible individuals with a new HIV-positive diagnosis, 475 (6.1%) met the criteria for RITA recent infection. The proportion of RITA recent infections among individuals with newly identified HIV was high among those aged 15–24 years (9.6%) and in men aged ≥65 years (10.3%) compared to other age groups; and were higher among women (6.7%) than men (5.1%). Of all recent cases, 68.8% were women, and 72.2% were aged 15–34 years. The Northern province had the fewest individuals with newly diagnosed HIV but had the highest proportion of recent infections (10.0%) compared to other provinces. Recent infections decreased by 19.6% per unit change in time (measured in months). Patients aged ≥25 years were less likely to have recent infection than those aged 15–24 years with those aged 35–49 years being the least likely to have recent infection compared to those aged 15–24 years (adjusted odds ratio [aOR], 0.415 [95% CI: 0.316–0.544]). Conclusion Public health surveillance targeting the areas and the identified groups with high risk of recent infection could help improve outcomes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018–2020

Rwibasira¹,

Malamba

Musengimana

et al. 2021

PLoS ONE

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“…Results were returned to the client at their next clinic visit. Detailed methods and results from this pilot have been described elsewhere [19].…”

Section: Study Populationmentioning

confidence: 99%

“…Women frequently did not return to the clinic for results and gave false contact details which hampered followup. The late return of a test result may have a negative impact on the value of the result to the client and their utility in informing prevention activities such as partner notification [19]. Delays in laboratory testing occurred due to failed assay runs or increased waiting time for the samples to be tested when recruitment was slow.…”

Section: Confounding Factorsmentioning

confidence: 99%

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

Wit

Rice

Risher

et al. 2021

BMC Health Serv Res

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Introduction 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. Methods We applied a RITA, incorporating a limited antigen (LAg) avidity assay, in different routine HIV service-delivery settings in 2018: antenatal care clinics in Siaya County, Kenya, HIV testing and counselling facilities in Nairobi, Kenya, and female sex workers clinics in Zimbabwe. Discussions were conducted with study coordinators, laboratory leads, and facility-based stakeholders to evaluate experiences and lessons learned in relation to implementing recency testing. Results In Siaya County 10/426 (2.3%) of women testing HIV positive were classified as recent, compared to 46/530 (8.7%) of women and men in Nairobi and 33/313 (10.5%) of female sex workers in Zimbabwe. Across the study setting, we observed differences in acceptance, transport and storage of dried blood spot (DBS) or venous blood samples. For example, the acceptance rate when testing venous blood was 11% lower than when using DBS. Integrating our study into existing services ensured a quick start of the study and kept the amount of additional resources required low. From a laboratory perspective, the LAg avidity assay was initially difficult to operationalise, but developing a network of laboratories and experts to work together helped to improve this. A challenge that was not overcome was the returning of RITA test results to clients. This was due to delays in laboratory testing, the need for multiple test results to satisfy the RITA, difficulties in aligning clinic visits, and participants opting not to return for test results. Conclusion We completed three pilot studies using HIV recency testing based on a RITA in Kenya and Zimbabwe. The main lessons we learned were related to sample collection and handling, LAg avidity assay performance, integration into existing services and returning of test results to participants. Our real-world experience could provide helpful guidance to people currently working on the implementation of HIV recency testing in sub-Saharan Africa.

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“…Third, as with all systematic reviews, our review process was imperfect and time-limited. Some meaningful literature was noted by our team after the review was complete, [107][108][109][110] and has not been included…”

Section: Limitationsmentioning

confidence: 99%

Use of HIV Recency Assays for HIV Incidence Estimation and Non-Incidence Surveillance Use Cases: A systematic review

Facente

Agyei²,

Maher

et al. 2021

Preprint

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IntroductionHIV assays designed to detect recent infection, also known as “recency assays,” are often used to estimate HIV incidence in a specific country, region, or subpopulation, alone or as part of recent infection testing algorithms (RITAs). Recently, many countries and organizations have become interested in using recency assays within case surveillance systems and routine HIV testing services, and in measuring other indicators beyond incidence, generally referred to as “non-incidence surveillance use cases.”MethodsTo identify best methodological and field implementation practices for the use of recency assays to estimate HIV incidence and trends in recent infections for key populations or specific geographic areas, we undertook: 1) a global Call for Information released from WHO/UNAIDS; and 2) a systematic review of the literature to: (a) assess the field performance characteristics of commercially available recency assays, (b) understand the use of recency testing for surveillance in programmatic and laboratory settings, and (c) review methodologies for implementing recency testing for both incidence estimation and non-incidence use cases.Results and discussionAmong the 90 documents ultimately reviewed, 65 (88%) focused on assay/algorithm performance or methodological descriptions, with high-quality evidence of accurate age- and sex- disaggregated HIV incidence estimation at national or regional levels in general population settings, but not at finer geographic levels for prevention prioritization. The remaining 25 documents described field-derived incidence (n=14) and non-incidence (n=11) use cases, including integrating RITAs into routine surveillance and assisting with molecular genetic analyses, but evidence was generally weaker or only reported on what was done, without validation data or findings related to effectiveness of recency assays when used for these purposes.ConclusionsHIV recency assays have been widely validated for estimating HIV incidence in age- and sex-specific populations at national and sub-national regional levels; however, there was a lack of evidence validating the accuracy and effectiveness of using recency assays for non-incidence surveillance use cases. The evidence identified through this review will be used in forthcoming technical guidance on the use of HIV recency assays for surveillance use cases by WHO and UNAIDS; further evidence on methodologies and effectiveness of non-incidence use cases is needed.

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Brief Report: Recent HIV Infection Surveillance in Routine HIV Testing in Nairobi, Kenya: A Feasibility Study

Cited by 16 publications

References 15 publications

Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018–2020

Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018–2020

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

Use of HIV Recency Assays for HIV Incidence Estimation and Non-Incidence Surveillance Use Cases: A systematic review

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