Characterizing HIV Acquisition Risk, Treatment Gaps, and Populations Reached Through Venue-Based Outreach and Clinical Services in Blantyre, Malawi: Findings From a District-wide CLOVE Study.

Background: In 2017, Blantyre district had the highest adult HIV prevalence in Malawi (17.7%) and lowest viral suppression (60%). In response, the Ministry of Health expanded prevention and treatment services. We assessed whether outreach to social venues could identify individuals with increased HIV acquisition risk or with unsuppressed HIV not currently reached by clinic-based services.

Methods: We conducted a cross-sectional biobehavioral survey in Blantyre, Malawi, from January to March 2022. We visited social venues where people meet new sexual partners and government clinics providing HIV testing or STI screening. Participants older than 15 years were interviewed and tested for HIV infection if not on ART. HIV recency tests were performed on those testing positive, and dried blood spots (DBS) were collected to quantify viral load and also to identify acute infection in those with HIV- results.

Results: HIV prevalence (18.5% vs 8.3%) and unsuppressed HIV infection (3.9% vs 1.7%) were higher among venue-recruited (n = 1802) than among clinic-recruited participants (n = 2313). Among PLHIV at both clinics (n = 199) and venues (n = 289), 79% were virally suppressed. Few had acute (n = 1) or recent infection (n = 8). Among women, HIV prevalence was 4 times higher (38.9% venue vs 8.9% clinic). At clinics, PLHIV reporting visiting venues were less likely to be suppressed (54.6 vs 82.6%). More men at venues than at clinics reported paying for sex (49% vs 30%) or having multiple sex partners in the past 4 weeks (32% vs 16%).

Conclusions: Enhanced venue-based prevention and testing for men and women could reduce treatment lapses, onward transmission, and improve HIV treatment outcomes.