Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection among Persons Newly Diagnosed with HIV in Thailand: Establishment, Implementation, Initial outcomes, and Lessons Learned (Preprint)

BACKGROUND A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand. OBJECTIVE To describe the establishment of the recent HIV infection surveillance and report lessons learned and initial outcomes from April through August 2022 METHODS We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the AsantéTM HIV-1 Rapid Recency® Assay. Duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 RESULTS Two hundred and one hospitals in 14 high-burden HIV provinces participated in surveillance. Of these, 69 reported ≥1 HIV diagnosis during the surveillance period. Of 1,053 newly diagnosed cases, 64 (6.1%) were classified as RITA-CS-recent. Self-reporting as transgender women (Adjusted Odds Ratio AOR: 7.41, 95% CI: 1.59-34.53) and men who have sex with men (AOR: 2.59, 95% CI: 1.02-6.56) compared to heterosexual, and students compared to office worker or employer (AOR: 3.76, 95% CI: 1.25-11.35) were associated with RITA-CS-recent infection in multivariate analysis. Proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow up and supervision visits were most commonly cited as lessons learned to inform the next surveillance phase. CONCLUSIONS Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. Key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HTS service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices.