Comparison of cohort characteristics in Central Africa International Epidemiology Databases to Evaluate AIDS and Demographic Health Surveys: Rwanda and Burundi

Abstract

Clinical health record data are used for HIV surveillance, but the extent to which these data are population representative is not clear. We compared age, marital status, body mass index, and pregnancy distributions in the Central Africa International Databases to Evaluate AIDS (CA-IeDEA) cohorts in Burundi and Rwanda to all people living with HIV and the subpopulation reporting receiving a previous HIV test result in the Demographic and Health Survey (DHS) data, restricted to urban areas, where CA-IeDEA sites are located. DHS uses a probabilistic sample for population-level HIV prevalence estimates. In Rwanda, the CA-IeDEA cohort and DHS populations were similar with respect to age and marital status for men and women, which was also true in Burundi among women. In Burundi, the CA-IeDEA cohort had a greater proportion of younger and single men than the DHS data, which may be a result of outreach to sexual minority populations at CA-IeDEA sites and economic migration patterns. In both countries, the CA-IeDEA cohorts had a higher proportion of underweight individuals, suggesting that symptomatic individuals are more likely to access care in these settings. Multiple sources of data are needed for HIV surveillance to interpret potential biases in epidemiological data.

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium

“…In addition, IeDEA sites may not be representative of HIV service delivery within some countries and regions, particularly in contexts where IeDEA sites were initially identified because they served a sizable patient population and/or offered advanced levels of care. This limitation notwithstanding, as IeDEA's 2020 site assessment survey included a large number of sites and settings that have participated in previous IeDEA-wide surveys, it is expected that temporal trends in HIV service delivery among IeDEA sites may be broadly reflective of prevailing trends across other HIV sites that are not part of the consortium [18].…”

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium

“…In addition, while the high overall response rate for the survey means that data are broadly representative for sites participating in IeDEA, these sites may not be representative of HIV service delivery within some countries and regions, particularly in contexts where IeDEA sites were initially identified because they served a sizable patient population and/or offered advanced levels of care. This limitation notwithstanding, as IeDEA's 2020 site assessment survey included a large number of sites and settings that have participated in previous IeDEAwide surveys, it is expected that temporal trends in HIV service delivery among IeDEA sites may be broadly reflective of prevailing trends across other HIV sites that are not part of the consortium [16].…”