However, the detection levels of these assays differ as key viral and serological markers evolve in AHI. Screening for epidemiological purposes has typically described the prevalence of established infections, limiting the understanding of ongoing transmission dynamics. HIV prevalence from anonymous testing of pregnant women and from nationally representative population-based household surveys remains the mainstay of HIV surveillance [10,15]. With increasing access DZNeP molecular weight to and uptake of ART, survival time of

those infected increases and the proportion with established infections increases over time, influencing the usefulness of HIV prevalence data for surveillance. Dissecting the relationship between prevalence and incidence becomes more complex as approaches to the epidemic become more advanced and widely available. Measuring HIV incidence Ku-0059436 cell line provides a more sensitive way of monitoring trends in HIV infection and behaviour. Enhancing current screening programmes to include tests for HIV-1 RNA and p24 antigen or the newer fourth-generation HIV-1 assays to monitor AHI and HIV incidence would provide a nuanced, sophisticated understanding of the epidemic, allowing more focused prevention and treatment efforts to be implemented and evaluated [8]. While the cost of identifying a single case of

AHI may be excessive at the individual level, evidence for enhanced spread during this stage of infection and the importance for broader public health benefit at the population level support the need to detect AHI to prevent secondary spread.

As this was an anonymous survey, we were unable to refer women diagnosed with AHI for care and support. We also believe that the HIV-1 RNA pooled NAAT strategy, Sitaxentan rather than the BED-CEIA, should be incorporated into the Department of Health’s annual anonymous National Antenatal Sentinel HIV and Syphilis Prevalence Surveys [10] to provide a parallel measure of incident HIV infections as ART is scaled up [9]. There are several limitations to our study. It is difficult to extrapolate our data to the general population because of the small sample size; because the survey population comprised pregnant women seeking antenatal care; and because rates of new HIV infections are likely to be different during pregnancy [16]. However, the population represented is that of young, sexually active women, most affected by the virus [14]. The HIV-1 RNA pooled NAAT strategy is technically demanding, requiring laboratory expertise; has cost implications; may fail to detect or under-amplify some non-B subtypes; has lower specificity, as detectable low viral load is classified as positive; and has some loss of sensitivity due to the testing of pooled samples [6,8]. Since the ELISA was not repeated for all the samples, HIV antibody-negative samples could have been misclassified as false-positive.