In Africa, rapid testing for recent HIV infection (RTRI) is being scaled up; however, use of the recent infection testing algorithm (RITA), which uses viral load (VL) to confirm RTRI-recent infections, is not a widespread practice. We present results of recently acquired HIV infections among men who have sex with men (MSM), transgender women, and genderqueer (TGW/GQ) individuals with newly diagnosed HIV infection in Zimbabwe as per the national approach (RTRI) and applying a RITA. In 2019, 1,538 MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe were recruited to participate in a biobehavioral survey using respondent-driven sampling. Consenting participants received HIV testing and all HIV-positive specimens were tested with the RTRI Asanté HIV-1 Rapid Recency Assay, and for VL and CD4 count. RTRI-recent participants with unsuppressed VL (≥1,000 copies/mL) were classified as RITA-recent. Descriptive statistics were used to summarize results among RTRI-recent and RITA-recent participants. Among those tested for HIV (1,511/1,538), 22.5% (340/1,511) tested positive and of those, 55.0% (187/340) self-reported an HIV-negative or unknown status. Among these, 8.6% (16/187) were classified as RTRI-recent and 91.4% (171/187) were classified as RTRI-long term. After accounting for VL, RITA-recency was 1.1% (2/187). Two of 16 (12.5%) RTRI-recent infections were RITA-recent. VL among RITA-recent cases were 9,052 copies/mL and 40,694 copies/mL and both had CD4 counts <500. Data highlight misclassification of recent infections among MSM and TGW/GQ with newly diagnosed HIV infection using RTRI. With the incorporation of VL, >85% of RTRI-recent cases were reclassified as RITA-long term. True characterization of recent infections may not be possible without VL testing, which remains challenging in resource-limited settings.

中文翻译：

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津巴布韦新诊断 HIV 感染的男男性行为者、跨性别女性和性别酷儿人群近期的 HIV 感染情况：受访者驱动抽样调查的结果

在非洲，近期艾滋病毒感染的快速检测（RTRI）正在扩大；然而，使用病毒载量 (VL) 来确认 RTRI 近期感染的近期感染测试算法 (RITA) 并不是一种普遍的做法。我们根据国家方法 (RTRI) 和应用 RITA，介绍津巴布韦新诊断出 HIV 感染的男男性行为者 (MSM)、跨性别女性和性别酷儿 (TGW/GQ) 近期感染 HIV 的结果。2019 年，津巴布韦哈拉雷和布拉瓦约的 1,538 名 MSM 和 TGW/GQ 被招募参与使用受访者驱动抽样进行的生物行为调查。同意的参与者接受了 HIV 检测，所有 HIV 阳性标本均使用 RTRI Asanté HIV-1 快速新近度检测以及 VL 和 CD4 计数进行了检测。RTRI-最近的 VL 不受抑制的参与者（≥1，000 拷贝/mL) 被归类为 RITA-最近。描述性统计用于总结 RTRI 最近和 RITA 最近参与者的结果。在接受 HIV 检测的人群中 (1,511/1,538)，22.5% (340/1,511) 检测呈阳性，其中 55.0% (187/340) 自我报告 HIV 呈阴性或未知状态。其中，8.6% (16/187) 被归类为 RTRI-近期，91.4% (171/187) 被归类为 RTRI-长期。考虑到 VL 后，RITA 新近度为 1.1% (2/187)。16 例 (12.5%) RTRI 近期感染中有两例是 RITA 近期感染。RITA 近期病例中的 VL 分别为 9,052 拷贝/mL 和 40,694 拷贝/mL，两者的 CD4 计数均小于 500。数据突出显示使用 RTRI 将 MSM 和 TGW/GQ 中的近期感染错误分类为新诊断的 HIV 感染。随着 VL 的加入，> 85% 的 RTRI 近期病例被重新分类为 RITA 长期病例。