Recent HIV infection among women and men enrolling to care in urban clinics in Ethiopia

BACKGROUND: Early HIV diagnosis allows timely interventions to control HIV transmission. We have determined the proportion of recent infections among people living with HIV (PLHIV) enrolling to care in Ethiopia and identified factors associated with recent infection. METHODS: Participants (aged ≥ 15 years) newly enrolled in HIV care were recruited from urban clinics in central Ethiopia (2022-2024). We used a recent infection testing algorithm, combining limiting antigen avidity serology and viral load quantification, to determine HIV infection recency. Factors associated with recent infection were investigated using logistic regression analysis, including sex-stratified analyses. RESULTS: Among 622 participants (median age 35 years; 364 [58.5%] women), 42 (6.8%) had recent infection. Recent infection was more common among PLHIV aged 15-24 years compared to those > 24 years (adjusted odds ratio [aOR], 4.3; 95% confidence interval [CI], 2.1-8.6), and in PLHIV belonging to key and priority populations (aOR, 2.2; 95% CI, 1.1-4.2). In sex-stratified analyses, age 15-24 years remained significantly associated with recent infection in both men (unadjusted odds ratio, 6.4; 95% CI, 1.5-26.5) and women (aOR, 2.7; 95% CI,1.2-6.1), whereas belonging to key and priority populations was significantly associated with recent infection only among women (aOR, 2.4; 95% CI, 1.1-5.2). CONCLUSION: A low proportion of PLHIV newly enrolled in care had recently acquired HIV infection. Recent infection was more common among persons aged 15-24 years and women belonging to key and priority populations. Further scale-up of HIV testing services are needed to improve detection of recent infection, which could help in prevention of new infections.