Our study among a general adult population attending a facility-based HIV testing services revealed a high overall HIV burden, with a substantial proportion of acute HIV infection (AHI). Almost a quarter of newly diagnosed infections were AHI and would have been missed with routinely used rapid diagnostic tests. The low sensitivity of the Determine™ HIV Early Detect for detecting AHI when performed at the point of care using finger-prick blood samples in our study contrasts with other published evaluations from laboratory settings, calling into question its utility in improving AHI diagnosis at the point of care. The results also highlight the importance of field evaluations of the commonly used diagnostic tests. Finally, we identified several well-performing targeting approaches for AHI screening that reduced the proportion needed to test but still identifying most infections. We reaffirm the importance of AHI symptoms in targeting AHI strategies, and the need to adapt and validate screening approaches to the local context. We may not be able to end AIDS by 2030, unless we tackle AHI and adapt HIV testing strategies to the current epidemiological context. As shown in our study, people presenting at AHI phase may seek care at the health facilities and could be offered molecular testing. The scaling up of access to point-of-care molecular diagnostics during the Covid-19 pandemic has demonstrated the feasibility of this approach. Failing to address AHI in the context of frequent testing and high HIV status awareness is a missed opportunity at individual and public health level. This is even more important in the era of long-acting pre-exposure prophylaxis (PrEP) scale-up, with the risk of initiation PrEP during AHI period, and funding cuts on the other hand, with the risk of increased transmission due to decreased efforts in control strategies.