Viral Suppression Following Same-day Initiation Antiretroviral Therapy among Persons Aware of their Classification as...

Awareness of classification as recent or long-term HIV-infected, could potentially influence behavior that leads to differential ART outcomes. We examined whether persons aware of classification of their HIV infection as recent were more or less likely to initiate same-day antiretroviral therapy (ART) and have viral load suppression (VLS) 6-month post-ART initiation, compared to persons aware of classification of their HIV infection as long-term in a cohort of 1,238 adults newly diagnosed with HIV from August 2021 to October 2022 in Rwanda. All persons received a rapid test for recent infection (RTRI) at baseline and viral load (VL) testing at baseline and at follow-up (approximately 6-months post-ART initiation). Per study protocol recent infection testing algorithm (RITA), HIV infection was classified as RITA-recent (RTRI-recent and baseline VL ≥ 1000 copies/mL) or RITA-long-term (RTRI-long-term and baseline VL ≥ 1000) and recency test results were returned per national guidelines; persons with baseline VL < 1000 copies/mL were presumed previously diagnosed and on ART and excluded. Data were abstracted from Rwanda's case surveillance system. We calculated the proportion of persons with follow-up VLS (< 1000 copies/mL). We estimated Risk Ratios (RRs) for follow-up VLS. Nearly all (99.6%) persons initiated same-day ART. Follow-up VLS did not differ between persons aware of classification of their HIV infection as RITA-recent (94%) versus RITA-long-term (94%). Awareness of RITA classification was not associated with follow-up VLS (RR = 1.01 [95% confidence interval: 0.96-1.06]). In this setting where persons were aware of RITA-classification, the vast majority initiated same-day ART and achieved follow-up VLS, regardless of RITA-recent or -long-term infection.