Application of a Testing History-Based HIV-1 Incidence Estimator in 12 Sub-Saharan African Nations Open Access

Abstract

Background: Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward the Joint United Nations Programme on HIV/AIDS (UNAIDS)’ 90-90-90 goals. One commonly used method for incidence estimation is to test samples from nationally representative, cross-sectional surveys using laboratory-based incidence assays. However, this approach has several limitations. A proposed alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described that may generate more precise incidence estimates with smaller sample size.

Methods: Here, we apply this alternative method to nationally representative cross-sectional data from 12 sub-Saharan African nations with varying country-specific HIV prevalence.

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 (R²=0.96). Moreover, the testing history-based method estimates are more precise and can produce age- and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the transmission rate of HIV as well as the drivers of HIV incidence among and within countries.

Conclusion: Thus, the testing history-based method is a useful tool for estimating HIV incidence using cross-sectional survey data in the sub-Saharan African region.

Table of Contents

Abstract - 7

Background - 8

Methods -10

Results - 12

Discussion -14

Conclusion - 15

Table 1 - 16

Table 2 - 17

Figure 1- 18

Figure 2- 19

Figure 3- 19

Figure 4 - 20

Figure 5 - 21

Figure 6 - 21

Figure 7 - 22

Figure 8 - 23

References - 24

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Sub-Saharan History Global Testing Estimation HIV Incidence
Committee Chair / Thesis Advisor	Patrick Sullivan, Emory University
Committee Members	Andrew Voetsch, Centers for Disease Control

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