The Significant gap between new HIV infections and new diagnoses in the Eastern European country of Georgia

Nikoloz Chkhartishvili, Natia Dvali, Marine Karchava, Manana Ghvaberidze, Tamar Tchelidze, Tengiz Tsertsvadze


Background: HIV epidemic continues to grow in the Eastern European country of Georgia. It is well documented that people unaware of their HIV status are major contributors to the spread of the virus.


Aim: The aim of this study was to estimate number of new infections in 2015-2016 and to define gap between new infections and diagnoses.


Methods: The number of new HIV infections was estimated with two methods: recent infection testing algorithm (RITA) and Spectrum software modeling. RITA was conducted using limited antigen avidity (LAg) enzyme immunoassay (EIA) and incidence was estimated using McWalter/Welte formula. LAg EIA was performed according to manufacturer’s instructions on frozen remnant specimens initially used for HIV diagnosis. HIV infection was defined as recent if individual did not have evidence of longstanding infection and had recent infection on LAg EIA. Study covered two-year period of 2015-2016.


Results: Of 1421 (711 in 2015 and 710 in 2016) adults newly diagnosed with HIV, 1132 (80%) had complete data and quality blood specimens available and were included in RITA estimation. Among 1132 infections included 136 (12%) were classified as recent (13% in 2015 and 11% in 2016, p=0.33). Estimated 1300 persons were newly infected in 2015 and 1100 – in 2016 based on RITA-derived approach. Spectrum modeling showed that estimated 1100 persons were newly infected annually in 2015 and 2016. If all 1421 persons diagnosed during study period were newly infected, then detection rate would be 59-65%. However, after adjusting for 55% of late diagnoses reported during 2015-2016, detection rate dropped to 26-29%.


Conclusion: Study demonstrates that there is significant gap in diagnosis regardless of estimation method used. Substantial number of HIV positive persons unaware of their status is likely to contribute to the growing HIV epidemic in the country. Increased efforts are needed to reduce the number of people living with undiagnosed HIV.


HIV; recent infection; incidence; Eastern Europe; Georgia;

Full Text:



UNAIDS. Ending AIDS: Progress towards the 90-90-90 targets. Global AIDS Update. Geneva: UNAIDS; 2017.

Chkhartishvili N, Sharvadze L, Gabunia P, Abutidze A, Nikolaishvili M, Tsertsvadze T. Late HIV diagnosis in Georgia: public health and economic implications. Translational and Clinical Medicine-Georgian Medical Journal. 2016;1:11-14.

Chkhartishvili N, Chokoshvili O, Bolokadze N et al. Late presentation of HIV infection in the country of Georgia: 2012-2015. PLoS One. 2017;12:e0186835.

Global HIV STrtaegic Information Working Group. Recent infection testing algorithm technical update: Applications for HIV surveillance and programme monitoring. Geneva: UNAIDS; 2018.

Stover J, Brown T, Puckett R, Peerapatanapokin W. Updates to the Spectrum/Estimations and Projections Package model for estimating trends and current values for key HIV indicators. AIDS. 2017;31 Suppl 1:S5-S11.

Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41:1-19.

Brookmeyer R. Reconstruction and future trends of the AIDS epidemic in the United States. Science. 1991;253:37-42.

Centers for Disease Control and Prevention. Vital signs: HIV testing and diagnosis among adults--United States, 2001-2009. MMWR Morb Mortal Wkly Rep. 2010;59:1550-5.

Moyo S, Kotokwe KP, Mohammed T et al. Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana. AIDS Res Hum Retroviruses. 2017;33:17-18.

McWalter TA, Welte A. Relating recent infection prevalence to incidence with a sub-population of assay non-progressors. J Math Biol. 2010;60:687-710.

Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162:199-200.

Skarbinski J, Rosenberg E, Paz-Bailey G et al. Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Internal Medicine. 2015;175:588.

Country Coordinatting Mechanism. Country Reports for Global AIDS Monitoring. Tbilisi: Country Coordinatting Mechanism; 2005-2016.

Tsertsvadze T, Chkhartishvili N, Dvali N et al. Estimating HIV incidence in eastern European country of Georgia: 2010-2012. Int J STD AIDS. 2014;25:913-20.

Chokoshvili O, Kepuladze K, Tsintsadze M et al. High prevalence and incidence of HIV, syphilis and viral hepatitis among men who have sex with men in Georgia: Findings of the Georgian MSM Cohort. 16th European AIDS Conference. Milan, Italy; 2017.

Chkhartishvili N, McNutt L-A, Smith PF, Tsertsvadze T. Characteristics of HIV-infected women and factors associated with HCV seropositivity in the Republic of Georgia. AIDS Research and Therapy. 2011;8:25.

Dvali N, Karchava M, Chkhartishvili N et al. Transmission clusters among newly diagnosed HIV patients in the country of Georgia. Abstract # WEPEC639. 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Vancouver, BC, Canada; 2015.

Centers for Disease Control and Prevention. HIV Surveillance Report, 2016; vol. 28. . Atlanta: CDC; 2017.

Negin J, Gregson S, Eaton JW et al. Rising Levels of HIV Infection in Older Adults in Eastern Zimbabwe. PLoS One. 2016;11:e0162967.

UNAIDS. 90–90–90 - An ambitious treatment target to help end the AIDS epidemic. Geneva; 2014.

Tsertsvadze T, Chkhartishvili N, Sharvadze L et al. Outcomes of Universal Access to Antiretroviral Therapy (ART) in Georgia. AIDS Res Treat. 2011;2011:621078.

Chkhartishvili N, Sharvadze L, Chokoshvili O et al. Mortality and causes of death among HIV-infected individuals in the country of Georgia: 1989-2012. AIDS Res Hum Retroviruses. 2014;30:560-6.



  • There are currently no refbacks.


Become a REVIEWER 


ISSN: 2346-8491 (online)