High HIV incidence among HIV infected BUT undetected individuals seeking HIV voluntary counselling and testing services in the greater Masaka Region in Uganda

Introduction: HIV testing is at the cornerstone for interventions aimed at controlling the number of new HIV infections in Sub-Saharan Africa. The current HIV RDTs in use are not able to identify acute HIV infection. Methods: We collaborated with 10 health centers in Uganda, offering HIV voluntary counselling and testing services to obtain ‘left-over’ EDTA blood samples after HIV RDT. We investigated for HIV RNA using the GeneXpert HIV-1 Viral Load assay among individuals who had non-reactive Determine (HIV negative) or an inconclusive test result (Indeterminate). We used a formula from Brookmeyer and Quinn to estimate HIV incidence. The study started on the 17 th February 2021 and ended on the 24 th December 2021. Study activities were suspended between June and September 2021, due to travel restrictions instituted by government of Uganda aimed at reducing levels of connectivity between and within communities, to curb the rising number of COVID-19 infections. Results: Fourteen of 4,941 ‘left-over’ plasma samples retested were reactive with a mean pVL of 1.5X10 6 copies per ml. The overall HIV incidence per 100 person years was 7.4 (95% CI: 4.3-12.5): higher for females at 9.4 (95% CI: 5.2-16.9) compared to 4.2 (95% CI: 1.3-12.9) for males. The HIV Incidence per 100 person years was 7.8 (95% CI: 3.7-16.4) before travel restrictions were instituted and 7.0 (95% CI: 3.3-14.7) after they were lifted. Conclusion: We demonstrated that incident HIV infection can be determined without assembling a longitudinal cohort. GeneXpert HIV-1 Viral Load assay can detect acute infection. There is no evidence that COVID-19 travel restrictions was associated with increased HIV Incidence rates in our communities.