Harriet S. Jones, Fortunate Machingura, Leah Gaihai, Memory Makamba, Thomas Chanyowedza, Panganai Masvikeni, Edward Matsikire, Primrose Matambanadzo, Sithembile Musemburi, Phillip N. Chida, Jeffery Dirawo, Owen Mugurungi, Sarah Bourdin, Bernadette Hensen, Lucy Platt, Gary Murphy, James R. Hargreaves, Frances M. Cowan, Brian Rice
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We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. 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引用次数: 0
摘要
导言：在重点人群艾滋病毒检测计划中，确定新感染艾滋病毒的人群、跟踪发病率并采取预防和治疗干预措施，对于实现艾滋病毒疫情控制至关重要。作为 "近期感染检测算法"（RITA）一部分的近期感染 HIV 实验室检测是支持这项工作的潜在工具。我们在津巴布韦为女性性工作者（FSWs）实施了 RITA，以探索机会和项目效益：在 2021 年 10 月至 2023 年 1 月期间，我们为参加津巴布韦性健康与艾滋病研究中心（CeSHHAR）重点人群项目的女性性工作者提供了回顾性检测。在 10 个省的 86 个诊所采集了干血斑 (DBS) 样本，并进行了实验室 LAg 阳性和病毒载量检测。我们对 RITA 结果进行了分析，并将其与计划数据联系起来，以探索地域差异并计算 HIV 感染率。我们介绍了同时对 HIV 检测呈阳性者的社会接触者（社会网络检测 [SNT]）和性接触者（指数病例检测 [ICT]）进行 HIV 检测的情况：结果：在项目地点接受检测的 24 976 名女性外阴残割者中，9.5%（2363/24 976）被确诊为 HIV 阳性。我们将 55.5%（1311/2363）符合条件的 HIV 阳性女性外阴残割者纳入研究，其中 11.7%（153/1311）被确认为最近感染了 HIV。样本处理时间的中位数为 37 天（IQR 20-67）。各省的登记率不同，但近期感染 HIV 的比例相似（范围：18.4% 至 4.0%）。总的 HIV 感染率为每 100 人 3.4 例（95% CI 2.7-4.0）。在结果可与常规收集数据联系起来的情况下，我们没有发现证据表明，与长期感染艾滋病病毒者相比，新近感染艾滋病病毒者的 ICT 接触者和 SNT 接触者的检测阳性率存在差异：在一项全国性的性工作者计划中实施 RITA 是可行的，虽然实施起来具有挑战性，但它可以帮助我们了解传播动态和艾滋病的发病率。招募和数据链接不够理想限制了我们对研究结果的解释，也限制了通过集中开展艾滋病预防工作而取得战略成果的机会。
Recent infection testing to inform HIV prevention responses and surveillance in a programme context: lessons from implementation within a nationally scaled female sex worker programme in Zimbabwe
Introduction
In the context of key population HIV testing programmes, identifying new HIV acquisitions, tracking incidence, and responding with prevention and treatment interventions will be critical for achieving HIV epidemic control. Laboratory tests for recently acquired HIV used as part of a “recent infection testing algorithm” (RITA), offer a potential tool to support this work. We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits.
Methods
Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive.
Results
Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. We enrolled 55.5% (1311/2363) of eligible HIV-positive FSWs to our study, of whom 11.7% (153/1311) were identified as having recently acquired HIV. It took a median of 37 days (IQR 20–67) for samples to be processed. Enrolment rates varied between provinces but the proportion of recently acquired HIV was similar (range: 18.4% to 4.0%). Overall HIV incidence was 3.4 (95% CI 2.7−4.0) per 100py. Where results could be linked to routinely collected data, we found no evidence of a difference in test-positivity between the ICT and SNT contacts of those with recently acquired compared to those with long-term HIV.
Conclusions
Implementation of a RITA was possible within a nationally scaled sex worker programme, and while challenging to implement, can provide an understanding of transmission dynamics and HIV incidence in this context. Sub-optimal recruitment and data linkage limited the interpretation of our findings and opportunities for strategic gains though focusing on HIV prevention efforts.
期刊介绍：
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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