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. 2021 Nov 17;16(11):e0259708.
doi: 10.1371/journal.pone.0259708. eCollection 2021.

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

Gallican N Rwibasira  1 , Samuel S Malamba  2 , Gentille Musengimana  3 , Richard C M Nkunda  2 , Jared Omolo  2 , Eric Remera  3 , Vedaste Masengesho  1 , Valens Mbonitegeka  3 , Tafadzwa Dzinamarira  1 , Eugenie Kayirangwa  2 , Placidie Mugwaneza  3
Affiliations

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

Gallican N Rwibasira et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. The Asante Rapid Test and Recent Infection Testing Algorithm (RITA).
Fig 2
Fig 2. Flow diagram of final HIV recency testing outcome by assay outcome in Rwanda (2018–2020).
Fig 3
Fig 3. Newly diagnosed and recent HIV infections by province in Rwanda (2018–2020).
Fig 4
Fig 4
A. Indicating the final recent HIV infection proportions and B. Indicating the absolute number of recent HIV infections by district and sex in Rwanda (2018–2020).
Fig 5
Fig 5. Proportion of recent infections per month among individuals with newly identified HIV infection in Rwanda (2018–2020).
See this image and copyright information in PMC

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