Human immunodeficiency virus recency testing coverage and partner-notification-services among people-living with human immunodeficiency virus in low- and middle-income countries

Abstract

BACKGROUND

Human immunodeficiency virus (HIV) recency testing provides data that can be used to monitor the trend of new HIV infections. The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services (PNS) is not well documented.

AIM

To determine the pooled prevalence of recency testing coverage, recent infection, reclassification (recent to long-term infection) and PNS cascade among newly diagnosed people living with HIV.

METHODS

PubMed, Cochrane Library and Embase were searched for articles published between January 2018 and November 2024. Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm (RITA). Recency coverage was defined as proportion of people tested using rapid testing for recent infection (RTRI) among those newly diagnosed with HIV. RITA further classifies RTRI results using viral load results (≥ 1000 copies/mL vs < 1000 copies/mL) to confirm recency status. For studies with PNS, we evaluated the cascade: Number of partners elicited, successfully contacted, eligible for HIV testing, tested and HIV diagnosis. PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners. Using random effects models, we computed the pooled estimate of recency outcomes and 95% confidence intervals (CIs).

RESULTS

Twenty-five studies from 17-low- and middle-income countries were included. Of 276315 newly diagnosed people living with HIV, 79864 underwent RTRI with an overall pooled recency coverage of 87% (95%CI: 67-96). The pooled prevalence of RTRI and RITA recency were 12% (95%CI: 9-16) and 7% (95%CI: 4-10), respectively. Pooled prevalence of RTRI reclassification was 34% (95%CI: 22-49). Of the recent cases who agreed to PNS, 253 partners were elicited with an estimated elicitation ratio of 1:1.6. Among partners elicited, 99% were successfully contacted, 75% were eligible for testing, 68% tested for HIV, and 15% were diagnosed with HIV.

CONCLUSION

High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC. While PNS yielded moderate HIV diagnoses, its targeted approach remains a critical strategy for identifying undiagnosed cases.

Keywords: Human immunodeficiency virus recency testing coverage; Rapid test for recent infection; Recent infection testing algorithm; Partner notification services; Misclassification; Recent infection surveillance; Low- and mid-income countries

Core Tip: This systematic review and meta-analysis synthesizes evidence from low- and middle-income countries on the implementation of human immunodeficiency virus (HIV)-recency testing and its integration with partner notification services (PNS). The findings highlight high but uneven rapid testing for recent infection (RTRI) coverage, moderate RTRI-recent prevalence, and substantial diagnostic misclassification. One in every three recent infections was reclassified as long-term following a viral load confirmatory testing. While PNS demonstrated strong partners contact rates and high HIV yield, critical attrition occurred throughout the cascade. These results highlight the value of RITA-confirmed recency testing and suggest that recency-informed PNS could enhance HIV surveillance and epidemic control when guided by standardized protocols and supported by confirmatory testing.