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

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.

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.

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%).

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.

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By: Rutstein SE1, Pettifor AE, Phiri S, Kamanga G, Hoffman IF, Hosseinipour MC, Rosenberg NE, Nsona D, Pasquale D, Tegha G, Powers K, Phiri M, Tembo B,Chege W, Miller WC.

• 11Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 2Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 3Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 4Lightouse Trust, Lilongwe, Malawi 5UNC Project, Lilongwe, Malawi 6Division of AIDS, NIAID, NIH, Bethesda, MD. 

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