HIV-1 infection recency among individuals newly diagnosed with HIV in Greater Gaborone, Botswana

We characterized individuals with HIV type 1 (HIV-1) recent infection using a two-step recent infection testing algorithm (RITA) in recently diagnosed, antiretroviral therapy (ART)-naive individuals within the Greater Gaborone area in Botswana.

Plasma samples from a prospective longitudinal cohort study of individuals recently diagnosed with HIV within the Greater Gaborone area (2023-2024), the Tekodiso study, were used.

Recent infection classification was determined using Limiting Antigen Avidity (LAg-avidity), as well as HIV viral load greater than 1000 copies/ml. LAg-normalized optical density (ODn) 1.5 or less represented a recency window of within 130 days postinfection. HIV viral load in plasma was quantified by Abbott m2000sp/Abbott m2000rt.

A total of 157 participants were included in this analysis. Median age at enrolment was 34 years (Q1, Q3: 27, 41), and majority 102 (65%) were female. The median log 10 HIV viral load was 4.6 copies/ml (Q1, Q3: 3.9, 5.2). A total of 12 of 157: 7.6% [95% confidence interval (CI) 4.0-13] individuals were classified as having a recent infection. Recent infection was not associated with age, employment status, or nationality. We observed a lower likelihood of recent HIV infection with secondary or higher education level (OR = 0.1; 95% CI: 0.1- 0.9).

We report a 7.6% rate of HIV recent infection by LAg-based RITA in recently diagnosed ART-naive individuals in Botswana. Our results highlight the need for continued HIV infection surveillance to improve targeted interventions for the prevention of HIV acquisition within the country.