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Finding the missing: characterization of HIV recent infection clusters in Rwanda

Title
Finding the missing: characterization of HIV recent infection clusters in Rwanda
Presenter
Gallican N. Rwibasira
Authors
G. N. Rwibasira * (1), E. Poirot (2), C. Steiner (2), C. Wells (2), B. Bizimana (3), E. Dusabe (3), C. Kamanzi (3), V. Masengesho (3), V. Maliwa (3), G. Reid (2), A. Mulindabigwi (1), G. Musengimana (1), R. Mwesigwa (4), J. Omolo (4), T. Oluoch (4), D. Miller (5), A. B. Suthar (5), V. Mugisha (3), S. Saito (2,6), B. Sangwayire (1)
Institutions
(1) Rwanda Biomedical Center, Kigali, Rwanda, (2) ICAP at Columbia University, Mailman School of Public Health, New York, United States, (3) ICAP at Columbia University, Mailman School of Public Health, Kigali, Rwanda, (4) Centers for Disease Control and Prevention, Kigali, Rwanda, (5) Centers for Disease Control and Prevention, Atlanta, United States, (6) Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, United States

BACKGROUND: Real-time recent HIV infection surveillance can enhance case-finding and inform targeted prevention. To identify and respond to signals of recent HIV acquisition, Rwanda adopted an HIV recent infection response strategy in January 2020.
METHODS: HIV recent infection surveillance data from newly diagnosed adults ('¥15 years) were collected at 479 health facilities during February'September 2020. Blood samples from these adults were submitted to 9 laboratories to complete a Recent Infection Testing Algorithm (RITA). Investigation teams were sent to health facilities with '¥2 RITA recent HIV infections within a month'time-space cluster'to collate information from existing registers on index cases and their contacts. Data were abstracted and recorded on a recent HIV infection response form. Descriptive statistics were used to summarize the data.
RESULTS: Of 4,336 new HIV diagnoses that underwent recent infection testing, 191 (4%) were classified as RITA recent. Teams investigated 15 clusters comprised of 30 index cases who were RITA recent from 14 health facilities. Ninety-three percent (28/30) of these cases were initiated on ART and 73% (22/30) were offered partner notification services (PNS). Of those offered PNS, 100% agreed and listed 39 contacts (Contact Ratio: 1.7). Fifty-nine percent (23/39) of contacts were tested for HIV and 30% (7/23) were newly diagnosed with HIV, of whom 100% were initiated on ART. Of the 7 newly diagnosed with HIV, 43% (3/7) were RITA recent and 57% (4/7) were long-term (Table).


[Table. Summary of outcomes from HIV recent infection cluster investigations overall and by sex, February'September 2020]
CONCLUSIONS: Index cases with recent infections were linked to high-risk HIV-negative partners, as well as partners with known and unknown HIV-positive status. Recency surveillance, combined with index testing/PNS, can maximize the impact of HIV prevention interventions, including PrEP, and treatment support efforts to curb continued transmission and accelerate epidemic control.