Background:
Malawi has made significant progress towards UNAIDS 95-95-95 targets, yet awareness of HIV status is at 88.3% and lowest among young people, 15-24-year-old (76.2%). Low awareness of HIV status may contribute to further transmission in the population, therefore there is a need to better understand HIV testing history and transmission in this age group.
Methods:
We analyzed pooled recent HIV infection data to describe testing history and recent HIV infection (< 12 months) status among 8,389 newly HIV-diagnosed 15-24-year-olds from 251 sites across Malawi, between September 2019 - March 2022. HIV recent infection classification was based on a positive rapid test for recent infection and a viral load ≥1000 copies/ml. We calculated the proportion of consenting newly HIV-diagnosed participants classified with recent HIV infection by age, sex, residence, testing point, and self-reported testing history to describe differences related to risk and behavior.
Results:
Most newly HIV-diagnosed young people were female (84.1%), aged 23-24 years-old (32.1%), rural residents (60.4%), and diagnosed at voluntary counselling and testing points (53.8%). A history of reported prior HIV testing was less frequent in younger age groups (Figure 1). Among 15-24-year-olds, 32.9% of males and 16.1% of females reported no previous HIV testing history. Overall, 4.9% of new HIV diagnoses were classified as recent infections, with the highest proportions observed in Mzimba (8.5%) and Machinga (6.9%) districts, among breastfeeding women (8.2%), persons tested at sexually transmitted infection clinics (9.0%), persons with a prior test within the past 6 months (11.9-13.5%), and 17-18-year-olds (7.3%).
Conclusions:
These findings highlight gaps in HIV testing among young people by age and sex with the majority ( >95%) potentially having been infected for >12 months. Tailored and innovative HIV prevention and testing strategies for adolescents, young males, and pregnant and breastfeeding women may be needed for HIV epidemic control. Routine data collection and analysis of recent HIV infection data and triangulating various surveillance data sources can be utilized to inform targeted HIV testing and preventive strategies for young people.
Figure 1: The age/sex disaggregated proportion of young people with a positive HIV test and their reported time of last HIV test. 