Despite a decline in the number of HIV tests performed in PEPFAR countries that began before the COVID-19 pandemic, the percentage of positive tests has remained stable at around 4%. More importantly, an increasing number of people who test positive have started treatment, reaching 94% in 2021. This study was presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI 2022) by Dr Bakary Drammeh from the United States Centers for Disease Control and Prevention. .
The US President’s Emergency Plan for AIDS Relief (PEPFAR) changed its universal HIV testing guidelines in 2019 and instead moved to using targeted testing for those most at risk. to contract HIV. PEPFAR is now emphasizing the proven public health method of index testing – testing contacts of the person diagnosed with HIV who may be at risk. Another method is to use HIV risk screening algorithms to determine the risk profiles of people in the general population most likely to have contracted HIV and to test people in outpatient or community settings who achieve high scores. students. It is hoped that this will increase the efficiency of the tests and improve the detection of HIV cases.
To assess trends in HIV testing and linkage to care, researchers analyzed data from 41 PEPFAR countries for the period 2016 to 2021 for people aged 15 and older. This included the number of HIV tests performed overall and the number of positive results; these figures were used to calculate the percentage of positivity or yield rate – the number of positive HIV test results divided by the total number of tests performed.
The researchers also looked at the number of people with a positive test who started treatment during this period. This led to the calculation of a proxy linkage rate, or the number of individuals newly starting ART divided by the number of positive tests.
Most of the 41 PEPFAR countries studied are located in sub-Saharan Africa (22), with ten others in Asia, six in the Caribbean, two in Central and South America and one in Europe. This represents 99.3% of PEPFAR’s global HIV testing and treatment data.
Between January 2016 and June 2021, a total of 443 million HIV tests were performed in the 41 countries. Of these, 17.5 million were positive.
There was a 42% increase in testing, from 19 million tests in March 2016 to a peak of 27 million in September 2018. However, this number then decreased by 42% to 16 million tests in December 2019 , following the implementation of the new PEPFAR guidelines. and before the global pandemic. In June 2021, there were 15 million tests.
The number of positive results fell from around 900,000 in March 2016 to just under a million in September 2017. This number then decreased to 600,000 in June 2021.
The positive percentage was stable at around 5% between March 2016 and September 2017 and decreased to 3% in March 2018. It has then remained stable at around 4% since December 2019.
The number of people starting treatment increased from around 500,000 in March 2016 to 800,000 in September 2017. It fell to 600,000 in June 2021, reflecting the reduction in the number of people diagnosed with HIV.
The gap between diagnosis and linkage to care has narrowed: the proxy linkage rate has risen from a low of 66% in March 2016 to 94% in June 2021, showing that the vast majority of those who test positive are now linked to care. Nevertheless, COVID-19 had an impact by lowering this figure in 2020.
This analysis does not take into account the number of undiagnosed people by comparing positive tests to current estimates of HIV incidence in each country. However, Drammeh said PEPFAR has recently introduced additional risk screening tools that will hopefully be sensitive enough to identify those most at risk who may not be diagnosed.
In conclusion, since 2018, the number of HIV tests has decreased by five million, but the percentage positivity rate has remained relatively stable, indicating the benefit of more targeted testing efforts. Additionally, the number of newly diagnosed people linked to ART has increased significantly over this period.