Estimation of HIV-1 Incidence Using a Testing History-Based Method; Analysis From the Population-Based HIV Impact Assessment Survey Data in 12 African Countries

• Type of Material: Article
• Authors: Stephen A Gurley, Emory University; Paul W Stupp, United States Centers for Disease Control and Prevention; Ian E Fellows, United States Centers for Disease Control and Prevention; Bharat S Parekh, United States Centers for Disease Control and Prevention; Peter W Young, United States Centers for Disease Control and Prevention; Ray W Shiraishi, United States Centers for Disease Control and Prevention; Patrick Sullivan, Emory University; Andrew C Voetsch, Emory University
• Language: English
• Date: 2023-03-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000003123
• Title of Journal or Parent Work: JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
• Volume: 92
• Issue: 3
• Start Page: 189
• End Page: 196
• Grant/Funding Information: Supported by the US President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreements #U2GGH001271 and #U2GGH001226. The findings and conclusions of this document are those of the authors and do not necessarily represent the official position of the funding agencies.
• Keywords: HIV testing; MALAWI; health surveys; Immunology; INFECTION; TRENDS; HIV; Life Sciences & Biomedicine; Infectious Diseases; incidence; epidemiology methods; EPIDEMIC; ZIMBABWE; QUALITY; Science & Technology
• Research Categories: Health Sciences, Public Health

Abstract

Background:Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described.Methods:We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation.Results:The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method.Conclusions:The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data.