Alarmingly high recent human immunodeficiency virus infection burden among newly diagnosed individuals in Mongu District, Zambia

Abstract

Background: Human immunodeficiency virus (HIV) recency assays are essential for distinguishing recent infections (≤ 12 months) from long-term infections, enabling targeted interventions. Western province, Zambia, has the nation’s highest HIV prevalence (16%), yet recent infection data in Mongu District remain unknown.
Aim: To determine the burden of recent HIV infection and associated factors in Mongu District, Western province, Zambia.
Setting: The study was conducted in Mongu district, a provincial town in Western province in Zambia.
Methods: This cross-sectional analytical study was conducted from 12 February 2024 to 30 May 2024 in 19 health facilities in Mongu District offering HIV testing services (HTS), using Asante recency test kits to identify recent infections. A total of 771 newly diagnosed individuals were included, and logistic regression analysis was employed to identify factors associated with recent infections, with adjusted odds ratio (AOR) and 95% confidence interval (CI) calculated, and significance determined at a p-value < 0.05.
Results: Among 771 antiretroviral therapy (ART)-naïve individuals (median age 27 years; 71% female participants), 34% (n = 262) were identified as recent infections. Participants with medium (adjusted odds ratio [AOR] = 13.43, 95% confidence interval [CI]: 5.85–30.83) or low (AOR = 13.33, 95% CI: 5.67–31.33) HIV knowledge had higher odds compared to those with high knowledge (p < 0.001). Unsuppressed viral load (VL) (≥ 1000 copies/mL) showed the strongest association (AOR = 852.1, 95% CI: 521.1–1432; p < 0.001). Cluster of differentiation 4 (CD4) counts < 200 cells/mm³ had 1848-fold higher odds (AOR = 1848.2, 95% CI: 192.8–17714.1; p < 0.001). Clients who entered through the Prevention of Mother-to-Child Transmission had higher odds (adjusted odds ratio [AOR] = 2.67, 95% confidence interval [CI]: 1.11 – 6.11, p = 0.028) compared to the reference group.
Conclusion: Mongu District exhibits alarmingly high recent HIV infections (34%), concentrated among youth, women, and individuals with suboptimal knowledge.
Contribution: These findings underscore the urgent need for scaling recency testing, strengthening youth-focused prevention, and improving HIV literacy as critical public health priorities.