Abstract Body

Background:

HIV infections can be characterized as recent (acquired within the previous 12 months) using a rapid test for recent infection (RTRI) and a viral load (VL) ≥1,000 copies/mL as part of a recent infection testing algorithm (RITA). Recent HIV infection surveillance (RIS) aims to identify geographic areas and subpopulations where potential transmission is occurring in order to guide public health response. To better understand recent infections among breastfeeding women (BFW) accessing HIV testing services (HTS), we reviewed data from Malawi’s RIS system.

Methods:

We analyzed RIS data from July 2019 to July 2022, among individuals ≥13 years with an HIV-positive result, from 27 districts in Malawi. Proportions of RITA-recent infections were calculated by dividing RITA-recents by the total valid RTRI results. Proportions were calculated by demographic characteristics and statistically significant differences were identified using chi-square tests (p≤0.05).

Results:

Among 55,347 newly diagnosed HIV-positive clients with a RITA result, 666 (1.2%) were BFW. The median age of BFW was 25 (IQR: 22-30). Fifty-three BFW (8.0%) had a RITA-recent infection compared to 2.0%, 3.6%, and 3.4%, (p≤0.00) of males, non-pregnant females, and pregnant females, respectively. By age group, the proportion RITA-recent among BFW was 8.9%, 7.1%, 8.1%, and 0.0% among 15-24yo, 25-34yo, 35-44yo, and 45-54yo, respectively. Regarding HTS entry points, the maternal and child health/under 5, maternity, and post-natal entry points accounted for 32.1% of RITA-recent BFW, whereas voluntary testing and counseling accounted for 45.3%. Among RITA-recent BFW, 47 (88.7%) self-reported their last HIV test result as negative and 3 (5.7%) as inconclusive. Among RITA-recent BFW with a previous negative result, 93.6% received their last HIV test within the past year and 61.7% within the past 6 months.

Conclusions:

RIS in Malawi identified about one recent infection out of every eight newly diagnosed HIV+ breastfeeding women, although BFW contribute < 2% of new diagnoses at HTS. The majority of RITA-recent BFW tested negative within the past 6 months. This suggests that while antenatal testing programs have high coverage, risk of HIV acquisition persists throughout pregnancy and breastfeeding, therefore prevention strategies could be enhanced for this group. Future analyses that investigate risk factors and geographic variation could inform counseling messages, partner engagement, and prevention options.