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Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics and HIV Testing and Counseling Centers in Lilongwe, Malawi

Citation

Rutstein, Sarah E.; Pettifor, Audrey E.; Phiri, Sam; Kamanga, Gift; Hoffman, Irving F.; Hosseinipour, Mina C.; Rosenberg, Nora E.; Nsona, Dominic; Pasquale, Dana K.; & Tegha, Gerald, et al. (2016). Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics and HIV Testing and Counseling Centers in Lilongwe, Malawi. Journal of Acquired Immune Deficiency Syndromes, 71(3), 272-280. PMCID: PMC4752378

Abstract

BACKGROUND AND OBJECTIVES: Integrating acute HIV infection (AHI) testing into clinical settings is critical to prevent transmission and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi. METHODS: We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening. RESULTS: Nearly two-thirds (62.8%, 9280/14755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence=0.64%) - a 0.9% case-identification increase. Prevalence was higher at STI (1.03% (44/4255)) than HTC clinics (0.3% (15/5025), p<0.01), accounting for 2.3% of new diagnoses, vs 0.3% at HTC. Median viral load (VL) was 758,050 copies/ml; 25% (15/59) had VL >/=10,000,000 copies/ml. Median VL was higher at STI (1,000,000 copies/ml) compared to HTC (153,125 copies/ml, p=0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared to those tested at HTC (54.6% versus 6.7%, p<0.01). The risk score algorithm performed well in identifying persons with AHI at HTC (sensitivity=73%, specificity=89%). CONCLUSIONS: The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC. Remarkably high VLs and concomitant genital sores demonstrates the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.

URL

http://dx.doi.org/10.1097/qai.0000000000000853

Reference Type

Journal Article

Year Published

2016

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Rutstein, Sarah E.
Pettifor, Audrey E.
Phiri, Sam
Kamanga, Gift
Hoffman, Irving F.
Hosseinipour, Mina C.
Rosenberg, Nora E.
Nsona, Dominic
Pasquale, Dana K.
Tegha, Gerald
Powers, Kimberly A.
Phiri, Mcleod
Tembo, Bisweck
Chege, Wairimu
Miller, William C.

PMCID

PMC4752378