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Peer-reviewedCC BYPLOS One

Results of integrating recency testing into routine index testing services in Lusaka, Zambia: A mixed effects regression analysis

  • Jake M Pry1,2
  • Shilpa S Iyer1,3
  • Chilambwe Mwila1
  • Christiana Frimpong1
  • Misinzo Moono1
  • Musunge Mulabe1
  • Mirriam Nanyangwe1
  • Herbert Kapesa1
  • Lumbani Phiri1
  • Patricia Maritim1
  • Melissa M Arons4
  • Tiffiany M Aholou4
3 more authors
  • Carolyn Bolton Moore1,5
  • Theodora Savory-van Huis1
  • Michael E Herce1,6
6 affiliations
  1. 1Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
  2. 2Division of Epidemiology, School of Medicine, University of California, Davis, California, United States of America.
  3. 3Global Vaccine Preventable Diseases Laboratory Networks, World Health Organization, Geneva, Switzerland.
  4. 4Division of Global HIV and TB, Global Health Center, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  5. 5School of Medicine, University of Alabama, Birmingham, Alabama, United States of America.
  6. 6Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America.
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Abstract

Introduction: As countries move toward epidemic control, reaching PLHIV unaware of their status becomes increasingly difficult, necessitating targeted strategies like index testing. We evaluated a strategy incorporating identification of recent HIV acquisition into routine index testing in Zambia. Methods: Consecutive adults newly diagnosed with HIV at two Lusaka health facilities were enrolled into a pilot interventional cohort to undergo rapid test for recent infection (RTRI) and viral load testing per the national recent infection testing algorithm (RITA). Consenting participants received RITA results; those with recent infection were offered additional partner elicitation, assisted partner notification, and contact tracing after routine index testing services. We compared test positivity between contacts of index participants with long-term versus recent HIV acquisition and used regression and latent class analyses to identify factors associated with recent acquisition. Results: Between May 2021–March 2022, we enrolled 321 of 393 (81.7%) newly diagnosed PLHIV and analyzed 317, with median age 31 years (IQR: 25–37) and most (63.1%) female. HIV positivity did not differ between contacts of RITA-recent (28.6%) versus long-term (27.9%) index participants (p = 0.942). Recency was strongly associated with condomless sex at last sex (PR: 7.25, 95% CI: 3.06–17.19), which latent class analysis confirmed was consistently associated with other high-risk behaviors. Of 305 participants completing a social harms survey, 27 (8.9%) reported ≥1 harm attributed to recency testing. Conclusion: While integrating recency testing into routine index testing was feasible, our findings do not support its use to improve efficiency. Risk behavior assessment may help prioritize PLHIV for recency and index testing.

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Cite

BibTeXRIS
BibTeX
@article{pry2026results,
  title = {{Results of integrating recency testing into routine index testing services in Lusaka, Zambia: A mixed effects regression analysis}},
  author = {Jake M Pry and Shilpa S Iyer and Chilambwe Mwila and Christiana Frimpong and Misinzo Moono and Musunge Mulabe and Mirriam Nanyangwe and Herbert Kapesa and Lumbani Phiri and Patricia Maritim and Melissa M Arons and Tiffiany M Aholou and Carolyn Bolton Moore and Theodora Savory-van Huis and Michael E Herce},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361598},
  url = {https://doi.org/10.1371/journal.pone.0361598},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Results of integrating recency testing into routine index testing services in Lusaka, Zambia: A mixed effects regression analysis
AU  - Jake M Pry
AU  - Shilpa S Iyer
AU  - Chilambwe Mwila
AU  - Christiana Frimpong
AU  - Misinzo Moono
AU  - Musunge Mulabe
AU  - Mirriam Nanyangwe
AU  - Herbert Kapesa
AU  - Lumbani Phiri
AU  - Patricia Maritim
AU  - Melissa M Arons
AU  - Tiffiany M Aholou
AU  - Carolyn Bolton Moore
AU  - Theodora Savory-van Huis
AU  - Michael E Herce
PY  - 2026
DA  - 2026/10/30
JO  - PLOS One
DO  - 10.1371/journal.pone.0361598
UR  - https://doi.org/10.1371/journal.pone.0361598
AB  - Introduction: As countries move toward epidemic control, reaching PLHIV unaware of their status becomes increasingly difficult, necessitating targeted strategies like index testing. We evaluated a strategy incorporating identification of recent HIV acquisition into routine index testing in Zambia. Methods: Consecutive adults newly diagnosed with HIV at two Lusaka health facilities were enrolled into a pilot interventional cohort to undergo rapid test for recent infection (RTRI) and viral load testing per the national recent infection testing algorithm (RITA). Consenting participants received RITA results; those with recent infection were offered additional partner elicitation, assisted partner notification, and contact tracing after routine index testing services. We compared test positivity between contacts of index participants with long-term versus recent HIV acquisition and used regression and latent class analyses to identify factors associated with recent acquisition. Results: Between May 2021–March 2022, we enrolled 321 of 393 (81.7%) newly diagnosed PLHIV and analyzed 317, with median age 31 years (IQR: 25–37) and most (63.1%) female. HIV positivity did not differ between contacts of RITA-recent (28.6%) versus long-term (27.9%) index participants (p = 0.942). Recency was strongly associated with condomless sex at last sex (PR: 7.25, 95% CI: 3.06–17.19), which latent class analysis confirmed was consistently associated with other high-risk behaviors. Of 305 participants completing a social harms survey, 27 (8.9%) reported ≥1 harm attributed to recency testing. Conclusion: While integrating recency testing into routine index testing was feasible, our findings do not support its use to improve efficiency. Risk behavior assessment may help prioritize PLHIV for recency and index testing.
SN  - 1932-6203
ER  -