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

Journal Article (Journal Article)

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) clinics 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%, 9280/14,755) 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 at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥ 10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with 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 with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%). CONCLUSIONS: The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.

Full Text

Duke Authors

Cited Authors

  • Rutstein, SE; Pettifor, AE; Phiri, S; Kamanga, G; Hoffman, IF; Hosseinipour, MC; Rosenberg, NE; Nsona, D; Pasquale, D; Tegha, G; Powers, KA; Phiri, M; Tembo, B; Chege, W; Miller, WC

Published Date

  • March 1, 2016

Published In

Volume / Issue

  • 71 / 3

Start / End Page

  • 272 - 280

PubMed ID

  • 26428231

Pubmed Central ID

  • PMC4752378

Electronic International Standard Serial Number (EISSN)

  • 1944-7884

Digital Object Identifier (DOI)

  • 10.1097/QAI.0000000000000853


  • eng

Conference Location

  • United States