4.4 Article

A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics

期刊

出版社

JOHN WILEY & SONS LTD
DOI: 10.1002/jia2.25701

关键词

clinical trials; HIV epidemiology; sexually transmitted infections; diseases; Africa; HIV care continuum

资金

  1. National Institute of Allergy and Infectious Diseases at the National Institutes of Health [R01 AI114320, T32 AI070114]
  2. National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health [R01 DK108424]
  3. Fogarty International Center at the National Institutes of Health [D43 TW010060]
  4. Lilongwe District Health Office
  5. Malawi Ministry of Health
  6. UNC Project, Malawi

向作者/读者索取更多资源

Combining multiple HIV testing strategies, including acute HIV infection screening, partner notification, and social contact referral, increased the detection of undiagnosed HIV infections within the socio-sexual networks of PLWH in Malawi. This approach proved to be effective in increasing HIV status awareness and promoting linkage to care.
Introduction HIV diagnosis is the necessary first step towards HIV care initiation, yet many persons living with HIV (PLWH) remain undiagnosed. Employing multiple HIV testing strategies in tandem could increase HIV detection and promote linkage to care. We aimed to assess an intervention to improve HIV detection within socio-sexual networks of PLWH in two sexually transmitted infections (STI) clinics in Lilongwe, Malawi. Methods We conducted a randomized controlled trial to evaluate an intervention combining acute HIV infection (AHI) screening, contract partner notification and social contact referral versus the Malawian standard of care: serial rapid serological HIV tests and passive partner referral. Enrolment occurred between 2015 and 2019. HIV-seropositive persons (two positive rapid tests) were randomized to the trial arms and HIV-seronegative (one negative rapid test) and -serodiscordant (one positive test followed by a negative confirmatory test) persons were screened for AHI with HIV RNA testing. Those found to have AHI were offered enrolment into the intervention arm. Our primary outcome of interest was the number of new HIV diagnoses made per index participant within participants' sexual and social networks. We also calculated total persons, sexual partners and PLWH (including those previously diagnosed) referred per index participant. Results A total of 1230 HIV-seropositive persons were randomized to the control arm, and 561 to the intervention arm. Another 12,713 HIV-seronegative or -serodiscordant persons underwent AHI screening, resulting in 136 AHI cases, of whom 94 enrolled into the intervention arm. The intervention increased the number of new HIV diagnoses made per index participant versus the control (ratio: 1.9; 95% confidence interval (CI): 1.2 to 3.1). The intervention also increased the numbers of persons (ratio: 2.5; 95% CI: 2.0 to 3.2), sexual partners (ratio: 1.7; 95% CI: 1.4 to 2.0) and PLWH (ratio: 2.3; 95% CI: 1.7 to 3.2) referred per index participant. Conclusions Combining three distinct HIV testing and referral strategies increased the detection of previously undiagnosed HIV infections within the socio-sexual networks of PLWH seeking STI care. Combination HIV detection strategies that leverage AHI screening and socio-sexual contact networks offer a novel and efficacious approach to increasing HIV status awareness.

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