Early diagnosis and immediate treatment of HIV infection

Early diagnosis of HIV infection and immediate start of treatment will reduce HIV transmission and improve the health of people living with HIV. For this reason, this thesis aims to contribute to decreasing the time between HIV infection, subsequent diagnosis, initiation of HIV treatment and viral suppression. We developed and validated a screening score, which can improve recognition of acute and early HIV infection. This screening score can also increase testing yield, while limiting the number of individuals requiring testing. We demonstrated the feasibility and effectiveness of strategies improving acute and early HIV infection diagnosis, facilitating same-visit confirmation of HIV diagnosis, same-day linkage to care and immediate initiation of HIV treatment. These strategies include peer-led distribution of HIV self-tests, a media campaign to create awareness for acute and early HIV infection, targeted testing for acute and early HIV infection, point-of-care HIV-RNA testing, partner notification services supported by peers, and initiation of HIV treatment on the day of HIV diagnosis. In summary, this thesis contributes to the implementation of effective strategies aiming at diagnosing and treating HIV infection at the earliest opportunity.