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

Abstract

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.

Recent HIV infection among newly diagnosed cases and associated factors in the Amhara regional state, Northern Ethiopia: HIV case surveillance data analysis (2019-2021)

“…Enhanced Response efforts to recent infections and/or cases with risk factors/group can be maximized through a strong coordination platform like a Public Health Emergency Operation Center. Nonetheless, the 14.2% finding in the present study is lower than the 30.4% finding in Germany ( 15 ), the 19% report from Singapore ( 16 ) and the 17% report in Uganda ( 17 ), but it is higher than the 9.5% finding from northern China ( 18 ), the 8.6% finding in Kenya ( 19 ), the 6.1% finding from Rwanda ( 20 ) and the 3% finding in Malawi ( 21 ). This difference comes from real variation in HIV incidence in the respective countries or difference in recent infection testing algorisms.…”

“…The first variable is being a female, which increases the likelihood of recent infection with over two folds as compared to males, which is also reported by WHO regional office for Africa ( 2 ), and other similar studies from Uganda and China ( 17 , 18 ). The reason might be more females are currently being engaged in risky sexual behaviors to cop-up with the growing living costs in the country, increased anatomical risks or might be associated with minimal women's decision role to have a safe sex ( 20 ).…”

Risk of mortality in HIV-infected COVID-19 patients: A systematic review and meta-analysis

“…Most people living with HIV (PLHIV) are from developing countries, with sub-Saharan Africa contributing the most significant burden. Despite advances in the knowledge of HIV prevention and treatment, significant numbers of incident HIV infections and AIDS-related deaths continue to happen globally [4] , with an estimated 680,000 AIDS-related deaths in 2020 alone [5] . AIDS is defined as the laboratory diagnosis of HIV infection plus either an opportunistic infection or a CD4 count of below 200/μL [1] .…”

Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study

“…Rwanda's adult (15 to 64 years) HIV prevalence is 3% with women facing a higher burden compared to men [5,10]. Although efforts such as screening blood donations, increased support for diagnostic services, health education, prevention services such as free condoms and scaling-up of antiretroviral therapy (ART) have greatly reduced HIV incidence in Rwanda, there exist strong gender disparities in terms of HIV prevalence and incidence [11][12][13]. The Rwanda Demographic and Health Survey (RDHS) 2020 further reports that 9% of Rwandan women engage in sexual intercourse with someone else other than their partner.…”

“…Moreover, regional studies have also shown healthcare providers' HIV knowledge scores to be low, with Rwanda scoring lower than the other countries [23]. Nonetheless, there is a dearth of information regarding comprehensive knowledge about HIV/AIDS among adolescents with most studies focusing on prevalence, incidence and ART uptake/adherence [3,8,10,11,13]. It is therefore crucial to understand and address HIV knowledge gaps among adolescents in order for programs and policymakers to design better and evidence-based behavior change interventions.…”