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


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.