Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe.
Experiences and lessons learned from the real-world implementation of an HIV recent infection testing algorithm in three routine service-delivery settings in Kenya and Zimbabwe.
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DOI：
10.1186/s12913-021-06619-6
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发表时间：
2021-06-22
影响因子：
2.8
通讯作者：
Murphy G
中科院分区：
文献类型：
--
作者：
de Wit MM;Rice B;Risher K;Welty S;Waruiru W;Magutshwa S;Motoku J;Kwaro D;Ochieng B;Reniers G;Cowan F;Rutherford G;Hargreaves JR;Murphy G
最近感染艾滋病毒的检测可以区分最近获得的感染和长期感染。鉴于目前对实施最新感染检测算法（RITA）的兴趣，我们报告了我们在三个试点研究中实施RITA的经验，并强调了在常规环境中进行最新检测时需要考虑的重要问题。2018年，我们在不同的常规艾滋病毒服务提供环境中应用了结合有限抗原（LAg）检测的RITA，包括肯尼亚Siaya县的产前保健诊所、肯尼亚内罗毕的艾滋病毒检测和咨询机构以及津巴布韦的女性性工作者诊所。与研究协调员、实验室负责人和基于设施的利益相关者进行了讨论，以评估与实施最新测试有关的经验和教训。在Siaya县，艾滋病毒检测呈阳性的妇女中有10/426（2.3%）被列为近期感染，而内罗毕的男女中有46/530(8.7%)，津巴布韦的女性性工作者中有33/313（10.5%）。在整个研究环境中，我们观察到干燥血斑（DBS）或静脉血样本在接受、运输和储存方面的差异。例如，测试静脉血的接受率比使用DBS时低11%。将我们的研究整合到现有的服务中，确保了研究的快速启动，并减少了所需的额外资源。从实验室的角度来看，LAg亲和度测定最初难以操作，但发展实验室和专家的合作网络有助于改进这一点。没有克服的一个挑战是将RITA测试结果返回给客户。这是由于实验室检测的延迟，需要多种检测结果来满足RITA，调整诊所就诊的困难，以及参与者选择不返回检测结果。我们在肯尼亚和津巴布韦完成了三项利用基于RITA的艾滋病毒近期检测的试点研究。我们学到的主要经验教训与样品收集和处理、LAg亲和分析性能、与现有服务的集成以及将测试结果返回给参与者有关。我们的实际经验可以为目前在撒哈拉以南非洲开展艾滋病毒近期检测工作的人们提供有益的指导。
Testing for recent HIV infection can distinguish recently acquired infection from long-standing infections. Given current interest in the implementation of recent infection testing algorithms (RITA), we report our experiences in implementing a RITA in three pilot studies and highlight important issues to consider when conducting recency testing in routine settings. We applied a RITA, incorporating a limited antigen (LAg) avidity assay, in different routine HIV service-delivery settings in 2018: antenatal care clinics in Siaya County, Kenya, HIV testing and counselling facilities in Nairobi, Kenya, and female sex workers clinics in Zimbabwe. Discussions were conducted with study coordinators, laboratory leads, and facility-based stakeholders to evaluate experiences and lessons learned in relation to implementing recency testing. In Siaya County 10/426 (2.3%) of women testing HIV positive were classified as recent, compared to 46/530 (8.7%) of women and men in Nairobi and 33/313 (10.5%) of female sex workers in Zimbabwe. Across the study setting, we observed differences in acceptance, transport and storage of dried blood spot (DBS) or venous blood samples. For example, the acceptance rate when testing venous blood was 11% lower than when using DBS. Integrating our study into existing services ensured a quick start of the study and kept the amount of additional resources required low. From a laboratory perspective, the LAg avidity assay was initially difficult to operationalise, but developing a network of laboratories and experts to work together helped to improve this. A challenge that was not overcome was the returning of RITA test results to clients. This was due to delays in laboratory testing, the need for multiple test results to satisfy the RITA, difficulties in aligning clinic visits, and participants opting not to return for test results. We completed three pilot studies using HIV recency testing based on a RITA in Kenya and Zimbabwe. The main lessons we learned were related to sample collection and handling, LAg avidity assay performance, integration into existing services and returning of test results to participants. Our real-world experience could provide helpful guidance to people currently working on the implementation of HIV recency testing in sub-Saharan Africa.
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