Impacts of Recent Infection Testing Integration into HIV Surveillance in Ekiti State, South West Nigeria: A Retrospective Cross Sectional Study

Background: Timely detection of recent HIV infections is critical in achieving the HIV epidemic. The aim of this study was to evaluate the effects of integrating the Recent Infection Testing Algorithm in HIV surveillance in Ekiti State, South West Nigeria. Method: Data from the Nigeria Medical Records System (NMRS)/National Data Repository (NDR) and Index Testing (IT) Services data capturing tools were abstracted for a retrospective cross-sectional study of 719 newly diagnosed HIV-positive cases who were screened for HIV incident infection using Asante rapid recency test kits between August 2020 and June 2022 at 5 selected recency testing health facilities. The venous blood (10 ml) of all the rapid Asante tested recent patients were collected into an EDTA tube and processed for viral load testing. The plasma level of HIV-1 RNA was quantified using the CAP/CTM and cobas 4800 platform at Obafemi Awolowo University Teaching Hospital PCR Laboratory Ife. Chi-square was used to characterize the recency status of the patients. A measure of the association was done using Chi-square, while the p-value of 0.05 was considered statistically significant. Results: The median age of the participants was 39 years. The result from the study showed that of the total number of 719 new cases of diagnosed HIV-positive, 626 of them were screened for rapid Test for Recency infection (RTRI) (87%). Overall, we found that 1.8% (11/626) of clients were classified as recent. The investigation also showed that from the index cases of the 11 confirmed recent infections, a total number of 125 additional positive cases were found. Conclusion: This result indicated a rise in the number of cases discovered in the State. Therefore, incorporating recency testing within regular HIV testing programs becomes essential in order to prioritize clients for index testing and provide useful information on transmission clusters.

Evaluation of the HIV Case-Based Surveillance System: A Pilot of the Electronic Health Record System in Mutare District, Zimbabwe, 2021

Background: Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. Methods: We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. Results: The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). Conclusion: The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.