Have We Met Before? Findings on HIV Retesting in Routine Healthcare Settings, Using Eswatini HIV-1 Recent Infection...

Eswatini is rapidly approaching the conditions needed to achieve and sustain HIV epidemic control. Repeating diagnostic testing of people living with HIV (PLHIV) already on antiretroviral therapy (ART) is not typically indicated, can lead to misidentification of new HIV diagnoses and distorts estimates of progress towards epidemic control. This study aimed to quantify retesting among PLHIV on ART and identify associated characteristics, using biomarker-based Recent Infection Surveillance data from routine HIV testing in Eswatini.

The Eswatini HIV-1 Recent Infection Surveillance (EHRIS) programme, launched in July 2019, offered a rapid test for recent infection (RTRI) to PLHIV 15 years and older who tested HIV-positive during routine HIV testing. We analysed survey data collected from 208 HIV testing locations (facility- and community-based) between July 2019 and February 2024. The analysis included data of PLHIV who did not disclose a prior HIV diagnosis during pre-test counselling and subsequently underwent an RTRI. We defined retesting among PLHIV with RTRI recent and VL <1000 copies/mL. Data were analysed to evaluate characteristics of retesting using Rao-Scott chi-square, bivariable and multivariable logistic regression.

Of 1925 adults who provided blood specimens for RTRI and VL testing, 781 (40.6%: 95% CI, 37.1-44.1) had suppressed VLs and were classified as retesting and likely on ART. The adjusted odds ratio (aOR) of retesting was higher if testing occurred at community locations (aOR = 1.9, p = 0.0007), during periods of more restrictive stay-at-home policy (aOR = 1.7, p = 0.005, aOR 2.6, p<0.0001, aOR = 2.1, p<0.0001), among females (aOR = 1.6, p = 0.002), pregnant females (aOR = 1.8, p = 0.001), co-habiting (aOR = 1.8, p = 0.02) or self-reported prior HIV testing (aOR = 1.3, p = 0.03).· CONCLUSIONS: Retests for HIV account for over a third of PLHIV with RTRI recent results in Eswatini. These findings can be used to improve the accuracy of models used to estimate national epidemic trends. Possible mitigation strategies could include strengthening client-centred care, better pre-test counselling, and integrated data systems to confirm previous HIV care status and minimize unnecessary HIV testing of PLHIV who are already on ART.