title: Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi.
abstract: OBJECTIVE
  Integrating acute HIV-infection (AHI) testing into clinical settings is critical to prevent transmission, and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) clinics and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi.
  
  
  METHODS
  We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening.
  
  
  RESULTS
  Nearly two-thirds (62.8%, 9280/14,755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence = 0.64%)-a 0.9% case-identification increase. Prevalence was higher at STI [1.03% (44/4255)] than at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥ 10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with HTC (153,125 copies/mL, P = 0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%).
  
  
  CONCLUSIONS
  The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.
authors.affiliation: *Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; §Lighthouse Trust, Lilongwe, Malawi; ‖UNC Project, Lilongwe, Malawi; and ¶Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Rutstein
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Pettifor
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.forename: Gift
authors.initials: G
authors.lastname: Kamanga
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.forename: Dominic
authors.initials: D
authors.lastname: Nsona
authors.forename: Dana
authors.initials: D
authors.lastname: Pasquale
authors.forename: Gerald
authors.initials: G
authors.lastname: Tegha
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.forename: Mcleod
authors.initials: M
authors.lastname: Phiri
authors.forename: Bisweck
authors.initials: B
authors.lastname: Tembo
authors.forename: Wairimu
authors.initials: W
authors.lastname: Chege
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D018023:HIV Seronegativity; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D012367:RNA, Viral