HIV-1 incidence in the era of rapid tests for recent infection in Livingstone District, Zambia

Abstract Objective HIV incidence is not well documented where health services are delivered as a result failure of better understanding current transmission of HIV in a community. The aim was to determine the incidence of HIV-1 and factors associated with recent infection in Livingstone district using the HIV-1 recent infection testing algorithm, using the Rapid test for recent infection with HIV viral load testing to identify true HIV recent patients infected within 12 months. Results This was a laboratory based cross sectional study in which samples of newly diagnosed HIV positive adults sent to LUTH PCR laboratory for Recency testing and HIV VL testing were used. In our study participants, the younger age group were more likely to have been infected in the past 12 months, median age: recently infected 28 (23, 37.5) vs long term 33 (27, 40) p-value = 0.002. Out of the 768 clients subjected to RITA, 18.75% were true HIV recent, with the majority of them being female at 59.51%. 50.74% of the clients classified as recent were virally unsuppressed, p- value =0.000. Mahatima Gandhi clinic had a high number of recent infections relative to other facilities at 17.36%. Majority of the clients were captured under index modality with a percentage of HIV recent patients at 47.22%. Adjusted analysis indicated a significant association between age, HIV VL and recent infection (OR 0.97; 95%CI 0.95-0.99; p- value=0.002) and (OR 0.32; 95%CI 0.22-0.48; p- value =0.000). A high HIV incidence of recent infection with a 50.74% HIV VL unsuppressed clients was observed suggestive of high HIV transmission rate in the community. The majority of clients were captured under index testing indicating that most clients are less likely to seek medical care for HIV testing. Being virally unsuppressed and age were associated with recent infection. Facilities servicing low income areas may be hot spot zones where preventive and treatment interventions should be prioritized in the district.