Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi

Background and Objectives:Integrating acute HIV-infection (AHI) testing into clinical settings is critical to prevent transmission, and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) clinics and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi.Methods:We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening.Results:Nearly two-thirds (62.8%, 9280/14,755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence = 0.64%)–a 0.9% case-identification increase. Prevalence was higher at STI [1.03% (44/4255)] than at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with HTC (153,125 copies/mL, P = 0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%).Conclusions:The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered

Modelling runoff quantity and quality in tropical urban catchments using storm water management model

Due to differences in rainfall regimes and management practices, tropical urban catchments are expected to behave differently from temperate catchments in terms of pollutant sources and their transport mechanism. Storm Water Management Model (SWMM) was applied to simulate runoff quantity (peakflow and runoff depth) and quality (total suspended solids and total phosphorous) in residential, commercial and industrial catchments. For each catchment, the model was calibrated using 8-10 storm events and validated using seven new events. The model performance was evaluated based on the relative error, normalized objective function, Nash-Sutcliffe coefficient and 1:1 plots between the simulated and observed values. The calibration and validation results showed good agreement between simulated and measured data. Application of Storm Water Management Model for predicting runoff quantity has been improved by taking into account catchment's antecedent moisture condition. The impervious depression storages obtained for dry and wet conditions were 0. 8 and 0. 2 mm, respectively. The locally derived build-up and wash-off parameters were used for modelling runoff quality