{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:02:12Z","timestamp":1780682532447,"version":"3.54.1"},"reference-count":33,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"MSF"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2026,5,19]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute HIV infection (AHI) is the brief period between viral acquisition and the appearance of HIV antibodies and cannot be detected by routinely used HIV rapid diagnostic tests (RDTs). Its role is likely to become increasingly important in the rapidly changing context of HIV testing in high-burden countries. We describe the characteristics of individuals attending HIV testing services (HTS) in rural Eswatini and the prevalence of newly diagnosed HIV, including AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults aged \u226518 years were enrolled at six routine HTS between June 2022 and April 2023. Participants completed detailed questionnaires. Routine HIV testing was conducted using the national serial RDT algorithm (Determine and Uni-Gold). HIV viral load (VL) analysis was performed on the Xpert platform (Xpert HIV-1 Viral Load, Cepheid) in the central laboratory. Newly diagnosed HIV was defined as a positive HIV RDT algorithm with detectable VL (established HIV), or negative or discordant HIV RDT together with VL \u226510\u2009000 copies\/mL (AHI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1095 participants with a median age of 27 years (IQR 22\u201333), 684 (61.5%) were women. Risk factors for HIV acquisition were common: &gt;1 sexual partner (332, 30.3%), condomless sex (452, 44.5%), not knowing main partner\u2019s HIV status (437, 42.8%). Symptoms consistent with AHI (713, 65.1%) and genito-urinary (660, 60.3%) infections were common. Overall, 41 participants (3.7%, 95%\u2009CI 2.7% to 5.0%) were diagnosed with HIV; 31 (2.8%, 95% CI 1.9% to 3.9%) with established HIV and 10 (0.9%, 95% CI 0.04% to 1.7%) with AHI, representing 24.4% (95% CI 12.4% to 40.3%) of new diagnoses. All participants diagnosed with AHI reported symptoms consistent with AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study among a general adult population attending HTS revealed a high overall HIV prevalence with a substantial proportion of AHI, highlighting the decreasing sensitivity of routine HTS to detect all HIV infections. To address AHI, accurate and accessible diagnostic tools and AHI testing guidance are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056838","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:20:41Z","timestamp":1780680041000},"page":"sextrans-2025-056838","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosing established and acute HIV in the context of facility-based HIV testing services in rural Eswatini: a cross-sectional study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0406-5218","authenticated-orcid":false,"given":"Iza","family":"Ciglenecki","sequence":"first","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"},{"name":"M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Kerschberger","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Mukooza","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skinner","family":"Lekelem","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nombuso","family":"Ntshalintshali","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpumelelo","family":"Mavimbela","sequence":"additional","affiliation":[{"name":"Eswatini National AIDS Programme, Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindisiwe","family":"Dlamini","sequence":"additional","affiliation":[{"name":"National Reference Laboratory, Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenhle","family":"Dube","sequence":"additional","affiliation":[{"name":"Eswatini National AIDS Programme, Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomvuyo","family":"Mabuza","sequence":"additional","affiliation":[{"name":"National Reference Laboratory, Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"de Latour","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melat","family":"Haile","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Ellman","sequence":"additional","affiliation":[{"name":"South African Medical Unit, M\u00e9decins Sans Fronti\u00e8res, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Keiser","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklaus Daniel","family":"Labhardt","sequence":"additional","affiliation":[{"name":"University Hospital Basel, Basel, Switzerland"},{"name":"University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindy","family":"Matse","sequence":"additional","affiliation":[{"name":"Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Calmy","sequence":"additional","affiliation":[{"name":"Institute of Global Health, University of Geneva, Geneva, Switzerland"},{"name":"HIV Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland"},{"name":"Center for Clinical Research, Geneva University Hospitals and University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026060510202583000_sextrans-2025-056838v1.1","unstructured":"Global AIDS update \u2014 AIDS, crisis and the power to transform. UNAIDS; 2025. Available: https:\/\/www.unaids.org\/en\/resources\/documents\/2025\/2025-global-aids-update [Accessed 30 Oct 2025]."},{"key":"2026060510202583000_sextrans-2025-056838v1.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004182","article-title":"The future of HIV testing in eastern and southern Africa: Broader scope, targeted services","volume":"20","author":"Grimsrud","year":"2023","journal-title":"PLoS Med"},{"key":"2026060510202583000_sextrans-2025-056838v1.3","doi-asserted-by":"crossref","first-page":"e284","DOI":"10.1016\/S2352-3018(20)30315-5","article-title":"Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa, 2000-20: a modelling study using survey and HIV testing programme data","volume":"8","author":"Gigu\u00e8re","year":"2021","journal-title":"Lancet HIV"},{"key":"2026060510202583000_sextrans-2025-056838v1.4","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.20.1.21579","article-title":"Clinical and public health implications of acute and early HIV detection and treatment: a scoping review","volume":"20","author":"Rutstein","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"2026060510202583000_sextrans-2025-056838v1.5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/QAI.0000000000003623","article-title":"Updates to HIV Transmission Rate Estimates Along the HIV Care Continuum in the United States, 2019","volume":"99","author":"Baxter","year":"2025","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026060510202583000_sextrans-2025-056838v1.6","doi-asserted-by":"crossref","unstructured":"Fajardo E , Lastrucci C , Jolivet P , et al . Should antigen-antibody rapid diagnostic tests be used to detect acute hiv infection? a systematic review and meta-analysis of diagnostic performance. HIV\/AIDS [Preprint] 2025. doi:10.1101\/2025.10.14.25338004","DOI":"10.1101\/2025.10.14.25338004"},{"key":"2026060510202583000_sextrans-2025-056838v1.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0164943","article-title":"Detection of Acute and Early HIV-1 Infections in an HIV Hyper-Endemic Area with Limited Resources","volume":"11","author":"Mayaphi","year":"2016","journal-title":"PLoS One"},{"key":"2026060510202583000_sextrans-2025-056838v1.8","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(02)09599-5","article-title":"Prevalence, incidence, and mother-to-child transmission of HIV-1 in rural South Africa","volume":"360","author":"Rollins","year":"2002","journal-title":"Lancet"},{"key":"2026060510202583000_sextrans-2025-056838v1.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2009.12.001"},{"key":"2026060510202583000_sextrans-2025-056838v1.10","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32833bb732"},{"key":"2026060510202583000_sextrans-2025-056838v1.11","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328335cda3"},{"key":"2026060510202583000_sextrans-2025-056838v1.12","doi-asserted-by":"publisher","DOI":"10.1172\/JCI200421540"},{"key":"2026060510202583000_sextrans-2025-056838v1.13","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000853"},{"key":"2026060510202583000_sextrans-2025-056838v1.14","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002794"},{"key":"2026060510202583000_sextrans-2025-056838v1.15","first-page":"530","article-title":"Targeted screening of young adults for acute HIV-1 infection at care seeking in Kenya","volume":"22","author":"Sanders","year":"2014","journal-title":"Top Antiviral Med"},{"key":"2026060510202583000_sextrans-2025-056838v1.16","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/QAD.0000000000002110","article-title":"Point-of-care HIV RNA testing and immediate antiretroviral therapy initiation in young adults seeking out-patient care in Kenya","volume":"33","author":"Sanders","year":"2019","journal-title":"AIDS"},{"key":"2026060510202583000_sextrans-2025-056838v1.17","unstructured":"Consolidated guidelines on differentiated HIV testing services. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240096394 [Accessed 14 Oct 2024]."},{"key":"2026060510202583000_sextrans-2025-056838v1.18","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/COH.0000000000000933","article-title":"Acute retroviral syndrome","volume":"20","author":"Lama","year":"2025","journal-title":"Curr Opin HIV AIDS"},{"key":"2026060510202583000_sextrans-2025-056838v1.19","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283474ed5"},{"key":"2026060510202583000_sextrans-2025-056838v1.20","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25419","article-title":"Challenges of HIV diagnosis and management in the context of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review","volume":"22","author":"Elliott","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2026060510202583000_sextrans-2025-056838v1.21","unstructured":"Eswatini final report 2021 - PHIA project %.. PHIA Project. Available: https:\/\/phia.icap.columbia.edu\/eswatini-final-report-2021\/ [Accessed 6 Oct 2024]."},{"key":"2026060510202583000_sextrans-2025-056838v1.22","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1111\/tmi.70011","article-title":"High Burden of Symptomatic and Asymptomatic Sexually Transmitted Infections in a Routine Decentralised HIV Care Setting in Eswatini: A Cross-Sectional Study","volume":"30","author":"Kerschberger","year":"2025","journal-title":"Trop Med Int Health"},{"key":"2026060510202583000_sextrans-2025-056838v1.23","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26517","article-title":"Low sensitivity of the fourth-generation antigen\/antibody HIV rapid diagnostic test DetermineTM HIV Early Detect for detection of acute HIV infection at the point of care in rural Eswatini: a diagnostic accuracy study","volume":"28","author":"Ciglenecki","year":"2025","journal-title":"J Int AIDS Soc"},{"key":"2026060510202583000_sextrans-2025-056838v1.24","unstructured":"Eswatini HIV integrated management guidelines. PrEPWatch; 2022. Available: https:\/\/www.prepwatch.org\/resources\/eswatini-hiv-integrated-management-guidelines-2022\/ [Accessed 06 Nov 2024]."},{"key":"2026060510202583000_sextrans-2025-056838v1.25","unstructured":"WHO implementation tool for pre-exposure prophylaxis of HIV infection: provider module for oral and long-acting PrEP. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240097230 [Accessed 28 Sep 2024]."},{"key":"2026060510202583000_sextrans-2025-056838v1.26","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1468-1293.2010.00838.x","article-title":"Screening for \u201cwindow-period\u201d acute HIV infection among pregnant women in rural South Africa","volume":"11","author":"Kharsany","year":"2010","journal-title":"HIV Med"},{"key":"2026060510202583000_sextrans-2025-056838v1.27","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000245"},{"key":"2026060510202583000_sextrans-2025-056838v1.28","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1097\/QAD.0000000000001134","article-title":"Sensitivity of HIV rapid tests compared with fourth-generation enzyme immunoassays or HIV RNA tests","volume":"30","author":"Tan","year":"2016","journal-title":"AIDS"},{"key":"2026060510202583000_sextrans-2025-056838v1.29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/09564624251371832","article-title":"Targeted approaches for acute HIV infection diagnosis in rural Eswatini","volume":"37","author":"Ciglenecki","year":"2026","journal-title":"Int J STD AIDS"},{"key":"2026060510202583000_sextrans-2025-056838v1.30","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200309050-00005"},{"key":"2026060510202583000_sextrans-2025-056838v1.31","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw666"},{"key":"2026060510202583000_sextrans-2025-056838v1.32","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/QAI.0000000000003287","article-title":"Concurrent Testing for COVID-19 and HIV Infection at 6 High-Volume Emergency Departments in a Priority Jurisdiction for Ending the HIV Epidemic in the United States","volume":"94","author":"McNulty","year":"2023","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026060510202583000_sextrans-2025-056838v1.33","unstructured":"Hidden costs: GeneXpert tests and Danaher\u2019s delayed audit. MSF Access; 2024. Available: https:\/\/msfaccess.org\/hidden-costs-genexpert-tests-and-danahers-delayed-audit [Accessed 06 Mar 2026]."}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056838","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:20:50Z","timestamp":1780680050000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":33,"alternative-id":["10.1136\/sextrans-2025-056838"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056838","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]}}}