HIV Recency Testing Preliminary experiences from Vietnam Dr

HIV Recency Testing Preliminary experiences from Vietnam Dr. Nguyen Hoang Long Director General, Vietnam Authority of HIV/AIDS Control (VAAC)

Contents Implementation timeline 2. Some initial findings 3. Conclusions 1.

HIV/AIDS Epidemic in Vietnam: Key Facts 35000 30000 § 96 millions pop 25000 § 250. 000 20000 § Concentrated epidemic: PWID (14%), MSM (12%), FSWs (3, 6%) § Reduce 2/3 during last 10 years. § 90 -90 -90 Targets: 15000 10000 5000 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 HIV AIDS Death PLWH 80 -70 -95

Recency Testing Implementation timeline Jul 2019 Jun 2018 Dec 2017 In-country lab validation Recency testing with 804 stored samples from 3 provinces • Integrate in the HIV Feb 2019 surveillance • Routine recency system (HSS+) testing in 10 in 20 provinces PEPFAR supported provinces 2020+ • Intergrate in the National HIV testing algorithm (? ) • Nationwide implementation (? )

Recency Testing on 804 Stored Samples to Better Understand the HIV epidemic, May 2018 508 # Samples 500 400 300 21. 7% 348 27. 8% 25% 381 20% 303 14. 2% 200 15% 212 10% 120 100 30% 43 106 26 0 5% 0% Son La Thanh Hoa Total HIV positive samples 01/07 -30/12 from VCT Hanoi # samples tested for recency Highland/Mountaino us Midland Urban/City % Recent 600 HIV positive samples, Recency Testing, and % of Samples as Recent (NO VL)

Recent Testing in 86 storedsamples, MSM cohort, Hanoi 2017 86 stored-samples Recency test and HIV VL 39 tested Recent 45 tested Long-term 30 confirmed recent (34. 9%) (Tested recent + VL≥ 1, 000 copies/m. L) 2 tested negative HIGH + YOUNG! Recent Infections: 34. 9% Average age: 23 yrs

Routine recency testing in 10 PEPFAR supported Province provinces, Feb – May 2019 Long An Number RTRI – Number confirm – tested on Number tested recent (VL>1000 RTRI-recent HIV VL cp/ml) 34 12 9 7 Đồng Nai 115 37 37 27 Binh Duong 100 22 22 17 Tây Ninh 47 19 10 10 • Start: Feb 2019 Tiền Giang 55 8 2 1 • So far, 1, 220 tests conducted/5 mths BR-Vũng Tàu 114 11 9 5 • Confirmed with VL: 110 (9. 0%) (some HCMC 243 33 31 30 Hải Phòng 51 6 6 4 Hà Nội 425 42 19 8 Thái Nguyên 36 3 3 1 1, 220 184 148 110 provinces did not carry out VL for all samples) Total

Recent Infection Among Target Group, Feb– May 2019 Share of KP Groups among recent infections, Feb – May 2019 Numbe of recent infection among target groups, 10 PEPFAR surged provinces, Feb – May 2019 30 25 25 14. 46% 20 14. 46% 15 65. 06% 10 7 6 5 1 2 4 1 1 2 1 6 1 3 3 2 2 3 0 Tây Ninh Long An Tien Giang MSM 6. 02% 6 Bình Dương BRVT HCMC Pw. ID Heterosexual 2 1 11 Thái Hải Nguyên Phòng Hà Nội 0 1 00 Other 1 MSM Pw. ID Heterosexual Others

Integrated Recency Test in National HSS+ in 20 Provinces, 2018 v To estimate proportion of recent infection among HIV positives and HIV incidence rate among KPs. Proportion of recent infection among HIV positive FSW 3. 03 MSM 6. 34 97. 0 93. 7 3. 00 PWID 97. 0 0 20 40 60 Recent infection v Results: – Highest recent infection: MSM 6. 34%. – Incidence rate among MSM: 1. 7% (per 100 -person years) 10 100 Long term infection Estimated Prevalence and Incidence 12 80 9. 71 11. 21 8 6 3. 6 4 2 0. 8 0. 24 1. 7 0 PWID FSW Prevalence Incident rate MSM

Recency Testing and Index-partner Testing: An Example from Binh Chanh District, Ho Chi Minh City INDEX Recent HIV+ Case (MSM, 22 Age) Part 1: HCMC – 155, MSM, Neg Pr. EP Part 2: HCMC – 156, MSM, Neg Pr. EP Part 3: HCMC – 157, MSM, Neg Pr. EP Part 4: HCMC – 158, POS, LT; 30 yrs Counselling ART

Integrate Recency Testing into National HIV Testing Algorithm? [1] To be approved by MOH as diagnostic test • Meet national requirements for licensing and importing to Vietnam. [2] To be included in the MOH’s HIV testing guideline • Meet national requirements on Sen (>99. 5%) & Spec (> 98%) • Recommended by WHO [3] To be used nationwide at the sites • Available in the markets • Reasonable price

Conclusions 1. Recency testing is useful to better understand the HIV/AIDS epidemics, especially estimate the new infection/incidence in different KPs, geographical areas for proper interventions. 2. Recency testing, combined with index-testing, helps to find partners for proper prevention (e. g. , Pr. EP) and ARV treatment timely. 3. Further steps need to be done to include Recency testing in Vietnam’s national HIV testing algorithm as a HIV diagnostic test.

Ha Long Bay, Vietnam