HIV RECENCY TEST: Cameroon Integrates Test to Distinct a Recent from a Long-term Infection.

Globally, in 2022, 39 million people globally were living with HIV, with 1.3 million new infections, leaving about 630 000 people deaths from AIDS-related illnesses. These figure indicate a 38% decline in annual new cases from 2010 to 2022, as well as a 69% decline in AIDS-related illnesses.

In Cameroon that same year (2022), an estimated 480 232 people were living with HIV, with 9905 new cases and a 2.6% prevalence (between 15 - 49 years), dropping from 2011.

HIV Positive Test: The recency test would be used to determin if it is recent, while other data capturing tools would help us determine who, where and why.

As Cameroon aligns with other countries moving closer to HIV epidemic control, some two very important modifications have been made in her testing policies;

1. The introduction of a 3-test algorithm, replacing the 2-tests for positive cases. Read more here.

2. The second is the integration of the HIV Recency Test to her national algorithm.

THE HIV RECENCY TEST

Definition:

HIV recency test is a rapid version of the Enzyme Immuno-assay (EIA) test that identifies whether HIV-1 infection in a person is recent (usually within a year or less) or long-term (over a year).

Purpose:

This test is designed uniquely for surveillance purpose, and has been used to estimate incidence in representative cross-sectional surveys and in epidemiological studies to better understand the patterns and distributions of new and longterm HIV infections.

With this test and assoociated data capturing tools, the following questions would be answered with precision;

1. Who has this new infection - from which the sub-populations?

2. Where are recent/new infections coming from - geograpical locations?

3. Why are they having these new infections - share common behaviours/practices, etc?

Answering the above questions about infections acquire within a period of 12 months ensure that available monitoring and control measures be directed towards specific areas and sub-populations having high levels of transmissions, as well as towards controling behaviours and practices presenting as risk factors.

As countries move closer to epidemic control, monitoring of recent HIV infections will allow us to target public health response to locations and sub-populations where high levels of transmissions are occurring.

Recent Infection Test Algorithm (RITA)

The recency test for HIV-1 is neither meant to be used for the initial diagnosis of a patient nor to serve as a test to distinct between HIV-1 and HIV-2. HIV screening test is only done with the new national algorithm. Patients found positive would immediately follow the treatment protocol, while meet the inclusion criteria would be eligible for the recency test, understanding that the test is basically for surveillance purpose.

The recency test itself however, has its own algorithm called the Recent Infection Test Algorithm (RITA) that only adds to the national algorithm - does not replace it.

Implementation:

HIV Recency Test: Practical session in the Meeting Hall of the Acha Presbyterian Hospital (July 9-10, 2024).

To ensure the the continuation of the implementation of this test the Ministry of health invited some over 30 health personnel directly involved in HIV testing to a training seminar in Bepanda, Douala at the Acha Presbyterian Hospital, from July 9 to 11, 2024.

During this 3-days capacity building seminar, trainers from the South HIV regional technical group, a US-based NGO, EGPAF, and CBCHB drilled participants on 15 modules, including practical sessions;

1. Overview of HIV Recent Infection Surveillance.

2. Integrating Recency Testing into HTS.

3. Ethics and Consent, Screening and Enrollment.

4. Data collection tools and forms

5. HIV-1 Rapid test for recent infection (RTRI); overview of principle and performance.

6. Sedia Asante stepwise procedure for RTRI.

7. Sample collection and handling.

8. RITA for Asante

9. Quality assurance for RTRI.

10. Laboratory tools for RTRI

11. Practical scenario.

12. Data quality management.

13. Confidentiality and data security.

14. Ensuring quality of RT and RTRI.

15. Hands on practice of data collection - Introduction.

HIV-1 Recency Rapid Test Results; Long-term (LT), Recent (RE), and Inconclusive.

Pre- and post-tests results were projected, and coupled with the practical session findings, they indicated excellent assimilation of knowledge and skills by the participants, and ready to be implemented at their different sites.

Trainers and sponsores expressed their satisfaction with the training, and urge all participants to immediately start off with a feedback training to permit other staff acquire the same knowledge for a smooth implementation.

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