背景:检测近期HIV感染可以区分近期获得性感染和长期感染。鉴于当前对实施最新感染测试算法(RITA)的兴趣,我们在三项试点研究中报告了我们在实施RITA方面的经验,并强调了在常规环境中进行近期性测试时需要考虑的重要问题。
方法:我们应用了RITA,纳入有限的抗原(LAg)亲合力测定,在2018年不同的常规HIV服务提供设置中:Siaya县的产前护理诊所,肯尼亚,内罗毕的艾滋病毒检测和咨询设施,肯尼亚,和津巴布韦的女性性工作者诊所。与研究协调员进行了讨论,实验室领导,和基于设施的利益相关者,以评估与实施最近度测试有关的经验和教训。
结果:在西亚亚县,10/426(2.3%)检测出HIV阳性的妇女被归类为最近,相比之下,内罗毕的男女人数为46/530(8.7%),津巴布韦的女性性工作者人数为33/313(10.5%)。在整个研究环境中,我们观察到接受的差异,干燥血斑(DBS)或静脉血样的运输和储存。例如,检测静脉血时的接受率比使用DBS时低11%.将我们的研究整合到现有服务中确保了研究的快速启动,并将所需的额外资源保持在较低水平。从实验室的角度来看,LAg亲和力测定最初很难操作,但是发展一个实验室和专家合作的网络有助于改善这一点。尚未克服的挑战是将RITA测试结果返回给客户。这是由于实验室测试的延误,需要多个测试结果来满足RITA,调整诊所就诊的困难,参与者选择不返回测试结果。
结论:我们在肯尼亚和津巴布韦完成了三项基于RITA的HIV近期检测试点研究。我们学到的主要教训与样品收集和处理有关,LAg亲和力测定性能,集成到现有服务并将测试结果返回给参与者。我们的实际经验可以为目前在撒哈拉以南非洲实施艾滋病毒近期检测的人们提供有益的指导。
BACKGROUND: Testing for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings.
METHODS: We applied a RITA, incorporating a limited antigen (LAg) avidity assay, in different routine HIV service-delivery settings in 2018: antenatal care clinics in Siaya County, Kenya, HIV testing and counselling facilities in Nairobi, Kenya, and female sex workers clinics in Zimbabwe. Discussions were conducted with study coordinators, laboratory leads, and facility-based stakeholders to evaluate experiences and lessons learned in relation to implementing recency testing.
RESULTS: In Siaya County 10/426 (2.3%) of women testing HIV positive were classified as recent, compared to 46/530 (8.7%) of women and men in Nairobi and 33/313 (10.5%) of female sex workers in Zimbabwe. Across the study setting, we observed differences in acceptance, transport and storage of dried blood spot (DBS) or venous blood samples. For example, the acceptance rate when testing venous blood was 11% lower than when using DBS. Integrating our study into existing services ensured a quick start of the study and kept the amount of additional resources required low. From a laboratory perspective, the LAg avidity assay was initially difficult to operationalise, but developing a network of laboratories and experts to work together helped to improve this. A challenge that was not overcome was the returning of RITA test results to clients. This was due to delays in laboratory testing, the need for multiple test results to satisfy the RITA, difficulties in aligning clinic visits, and participants opting not to return for test results.
CONCLUSIONS: We completed three pilot studies using HIV recency testing based on a RITA in Kenya and Zimbabwe. The main lessons we learned were related to sample collection and handling, LAg avidity assay performance, integration into existing services and returning of test results to participants. Our real-world experience could provide helpful guidance to people currently working on the implementation of HIV recency testing in sub-Saharan Africa.