Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe

BMC Health Services Research

Sitholubuhle Magutshwa¹  Frances Cowan²  John Motoku³  Gary Murphy⁴  Benard Ochieng⁵  Daniel Kwaro⁵  Brian Rice⁶  Georges Reniers⁶  Mariken M. de Wit⁶  James R. Hargreaves⁶  Kathryn Risher⁶  Susie Welty⁷  George Rutherford⁷  Wanjiru Waruiru⁷ 

[1] Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe;Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe;Liverpool School of Tropical Medicine, Liverpool, UK;Eastern Deanery AIDS Relief Programme, Nairobi, Kenya;Independent consultant in HIV laboratory diagnostics, London, UK;Kenya Medical Research Institute, Kisumu, Kenya;London School of Hygiene and Tropical Medicine, London, UK;University of California, San Francisco, USA;

关键词: HIV;    Recency testing;    RITA;    Zimbabwe;    Kenya;    Implementation;   

DOI  :  10.1186/s12913-021-06619-6

来源: Springer

【 摘 要 】

IntroductionTesting for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings.MethodsWe applied a RITA, incorporating a limited antigen (LAg) avidity assay, in different routine HIV service-delivery settings in 2018: antenatal care clinics in Siaya County, Kenya, HIV testing and counselling facilities in Nairobi, Kenya, and female sex workers clinics in Zimbabwe. Discussions were conducted with study coordinators, laboratory leads, and facility-based stakeholders to evaluate experiences and lessons learned in relation to implementing recency testing.ResultsIn Siaya County 10/426 (2.3%) of women testing HIV positive were classified as recent, compared to 46/530 (8.7%) of women and men in Nairobi and 33/313 (10.5%) of female sex workers in Zimbabwe. Across the study setting, we observed differences in acceptance, transport and storage of dried blood spot (DBS) or venous blood samples. For example, the acceptance rate when testing venous blood was 11% lower than when using DBS. Integrating our study into existing services ensured a quick start of the study and kept the amount of additional resources required low. From a laboratory perspective, the LAg avidity assay was initially difficult to operationalise, but developing a network of laboratories and experts to work together helped to improve this. A challenge that was not overcome was the returning of RITA test results to clients. This was due to delays in laboratory testing, the need for multiple test results to satisfy the RITA, difficulties in aligning clinic visits, and participants opting not to return for test results.ConclusionWe completed three pilot studies using HIV recency testing based on a RITA in Kenya and Zimbabwe. The main lessons we learned were related to sample collection and handling, LAg avidity assay performance, integration into existing services and returning of test results to participants. Our real-world experience could provide helpful guidance to people currently working on the implementation of HIV recency testing in sub-Saharan Africa.

【 授权许可】

CC BY