Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

Telford, Carson; Tessema, Zaena; Msukwa, Malango; Arons, Melissa; Theu, Joe; Bangara, Fred Fredrick; Ernst, Alexandra; Welty, Susie; O’Malley, Gabrielle; Dobbs, Trudy; Shanmugam, Vedapuri; Kabaghe, Alinune N.; Dale, Helen; Wadonda-Kabondo, Nellie; Gugsa, Salem; Kim, Andrea; Bello, George; Eaton, Jeffrey W.; Jahn, Andreas; Nyirenda, Rose; Parekh, Bharat; Shiraishi, Ray W.; Kim, Andrea A.; Tobias, James L.; Curran, Kathryn; Payne, Danielle; Auld, Andrew F.

doi:10.15585/mmwr.mm7109a1

Cited by 5 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Discussioncontrasting

confidence: 84%

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

Alemu

Ayalew

Mahteme

et al. 2022

Front. Public Health

View full text Add to dashboard Cite

BackgroundDistinguishing a recent from long-standing HIV infection is a critical step to reduce new infections in 2030. Therefore, this analysis determines the proportion of recent HIV infections among newly diagnosed cases and associated factors in the Amhara regional state between 2019 and 2021.MethodsWe got the HIV case-based surveillance dataset (July 2019 up to August 12/2021) from the Amhara Public Health Institute. Recent infection is an infection gained within the last 12 months as identified by Asante recency test kits. Logistic regression was carried out to identify factors associated with recent infection. Adjusted odd with 95% CI and a p-value of < 0.05 was considered to declare significant associations.ResultsOut of 5,689 eligible cases, 3,129 (55%) recency tests had been performed. The proportion of recent HIV infection is 443 (14.2%, 95% CI: 13, 15.4%). High proportion of recent infections is reported from Bahir Dar city (23.3%), Central Gondar (17.7%), West Gojjam (16.5%), North Shewa (16.5%) and South Gondar zones (15.7%). Besides, the proportion of recent infection is high among clients aged ≥ 51 years (32.4%), illicit drug users (30.6 %), homelessness (28.5%), current commercial sex workers (27.9%), prisoners (21.1%), and among clients with invasive medical procedures (22.2%). Recent infection is significantly associated with females (AOR: 1.9, 95% CI: 1.2–3.1), secondary and above education (AOR: 2.1, 95% CI: 1.3–3.4), commercial sex workers (AOR: 1.8, 95% CI: 1.2–2.7), having contact with index case (AOR: 0.5, 95% CI: 0.3–0.8) and illicit drug utilization (AOR: 3.6, 95% CI: 1.1–12.4).ConclusionIn the Amhara region, the proportion of recent HIV infection is high with marked variation across sociodemographic characteristics. We identified the risk or preventive factors associated with a recent infection. Therefore, all HIV responders should target their prevention efforts toward hot spot areas and sub-populations to stop further transmission.

show abstract

Section: Discussioncontrasting

confidence: 84%

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

Alemu

Ayalew

Mahteme

et al. 2022

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Focusing prevention resources on persons who are at higher risk of acquiring a recent infection should contribute to the continued decline in HIV incidence and, ultimately, to epidemic control. Additional strategies will be needed to monitor recent infections, such as routine surveillance as part of HIV testing services for rapid case and cluster investigations ( 30 – 32 ) or using testing history–based methods to classify recent infections within surveys that do not require the use of a recency assay ( 33 ). Those data will provide actionable information for HIV programs regarding new outbreak locations and where prevention resources might be needed most ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015–2019

Currie,

West,

Patel

et al. 2023

Emerg. Infect. Dis.

Self Cite

View full text Add to dashboard Cite

Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15–49 years of age who had sex during the previous year and used a recent infection testing algorithm to distinguish recent from long-term infections. We collected risk factor information via participant interviews and assessed correlates of recent infection using multinomial logistic regression, incorporating each surveyʼs complex sampling design. Compared with HIV-negative persons, persons with higher odds of recent HIV infection were women, were divorced/separated/widowed, had multiple recent sex partners, had a recent HIV-positive sex partner or one with unknown status, and lived in communities with higher HIV viremia prevalence. Prevention programs focusing on persons at higher risk for HIV and their sexual partners will contribute to reducing HIV incidence.

show abstract

“…Since recent HIV surveillance can generate a disaggregated summary of where recent HIV infections occur at more granular geographic sub-units, such as district and health facilities,16 the rapid identification of such HIV transmission clusters is the next important step in using the recent infection surveillance data in Malawi. This in fact has begun with a geospatial transmission ‘hotspot’ analysis using Malawi recency data 54. Continuing such analyses, and following them up with local facility-based investigations, may help explain our district-level recent infection findings more fully and can provide the basis for using recent infection surveillance to identify gaps in HIV prevention and care services 4 5 55 56…”

Section: Discussionmentioning

confidence: 99%

“…This in fact has begun with a geospatial transmission 'hotspot' analysis using Malawi recency data. 54 Continuing such analyses, and following them up with local facility-based investigations, may help explain our district-level recent infection findings more fully and can provide the basis for using recent infection surveillance to identify gaps in HIV prevention and care services. 4 5 55 56 The strength of this study includes the large sample of persons with new HIV diagnoses from districts in Malawi with high HIV prevalence.…”

Section: Open Accessmentioning

confidence: 99%

Characterising persons diagnosed with HIV as either recent or long-term using a cross-sectional analysis of recent infection surveillance data collected in Malawi from September 2019 to March 2020

et al. 2022

Self Cite

View full text Add to dashboard Cite

ObjectivesIn Malawi, a recent infection testing algorithm (RITA) is used to characterise infections of persons newly diagnosed with HIV as recent or long term. This paper shares results from recent HIV infection surveillance and describes distribution and predictors.SettingData from 155 health facilities in 11 districts in Malawi were pooled from September 2019 to March 2020.ParticipantsEligible participants were ≥13 years, and newly diagnosed with HIV. Clients had RITA recent infections if the rapid test for recent infection (RTRI) test result was recent and viral load (VL) ≥1000 copies/mL; if VL was <1000 copies/mL the RTRI result was reclassified as long-term. Results were stratified by age, sex, pregnancy/breastfeeding status and district.Results13 838 persons consented to RTRI testing and 12 703 had valid RTRI test results and VL results after excluding clients not newly HIV-positive, RTRI negative or missing data (n=1135). A total of 12 365 of the 12 703 were included in the analysis after excluding those whose RTRI results were reclassified as long term (n=338/784 or 43.1%). The remainder, 446/12 703 or 3.5%, met the definition of RITA recent infection. The highest percentage of recent infections was among breastfeeding women (crude OR (COR) 3.2; 95% CI 2.0 to 5.0), young people aged 15–24 years (COR 1.6; 95% CI 1.3 to 1.9) and persons who reported a negative HIV test within the past 12 months (COR 3.3; 95% CI 2.6 to 4.2). Factors associated with recent infection in multivariable analysis included being a non-pregnant female (adjusted OR (AOR) 1.4; 95% CI 1.2 to 1.8), a breastfeeding female (AOR 2.2; 95% CI 1.4 to 3.5), aged 15–24 years (AOR 1.6; 95% CI 1.3 to 1.9) and residents of Machinga (AOR 2.0; 95% CI 1.2 to 3.5) and Mzimba (AOR 2.4; 95% CI 1.3 to 4.5) districts.ConclusionsMalawi’s recent HIV infection surveillance system demonstrated high uptake and identified sub-populations of new HIV diagnoses with a higher percentage of recent infections.

show abstract

Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

Cited by 5 publications

References 8 publications

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

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

Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015–2019

Characterising persons diagnosed with HIV as either recent or long-term using a cross-sectional analysis of recent infection surveillance data collected in Malawi from September 2019 to March 2020

Contact Info

Product

Resources

About