Cross-Sectional Human Immunodeficiency Virus Incidence Estimation Accounting for Heterogeneity Across Communities

Xu, Yuejia; Laeyendecker, Oliver; Wang, Rui

doi:10.1111/biom.13046

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…While these studies represented a diverse assemblage, they fell broadly into several categories. A total of 5 presented statistical methodologies for managing uncertainties in the window periods of recency assays [ 12 , 33 , 40 , 67 , 70 ]; 3 provided a comparison of the results of assay-based estimates of HIV incidence with estimates using other incidence methods such as longitudinal surveys, acute infection (RNA positive/antibody negative) staging within cohorts, and dynamic models such as UNAIDS Estimation Projection Package (EPP)/Spectrum and Thembisa [ 39 , 43 , 57 ]; 2 studies presented novel statistical methods for estimating HIV incidence from the use of recency assays in cross-sectional surveys [ 31 , 48 ]. Bao et al [ 46 ] adapted the UNAIDS EPP to incorporate data from incidence assays, to narrow the uncertainty intervals of estimated incidence.…”

Section: Resultsmentioning

confidence: 99%

Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review

Facente¹,

Grebe²,

Maher³

et al. 2022

JMIR Public Health Surveill

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Background HIV assays designed to detect recent infection, also known as “recency assays,” are often used to estimate HIV incidence in a specific country, region, or subpopulation, alone or as part of recent infection testing algorithms (RITAs). Recently, many countries and organizations have become interested in using recency assays within case surveillance systems and routine HIV testing services to measure other indicators beyond incidence, generally referred to as “non-incidence surveillance use cases.” Objective This review aims to identify published evidence that can be used to validate methodological approaches to recency-based incidence estimation and non-incidence use cases. The evidence identified through this review will be used in the forthcoming technical guidance by the World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) on the use of HIV recency assays for identification of epidemic trends, whether for HIV incidence estimation or non-incidence indicators of recency. Methods To identify the best methodological and field implementation practices for the use of recency assays to estimate HIV incidence and trends in recent infections for specific populations or geographic areas, we conducted a systematic review of the literature to (1) understand the use of recency testing for surveillance in programmatic and laboratory settings, (2) review methodologies for implementing recency testing for both incidence estimation and non-incidence use cases, and (3) assess the field performance characteristics of commercially available recency assays. Results Among the 167 documents included in the final review, 91 (54.5%) focused on assay or algorithm performance or methodological descriptions, with high-quality evidence of accurate age- and sex-disaggregated HIV incidence estimation at national or regional levels in general population settings, but not at finer geographic levels for prevention prioritization. The remaining 76 (45.5%) described the field use of incidence assays including field-derived incidence (n=45), non-incidence (n=25), and both incidence and non-incidence use cases (n=6). The field use of incidence assays included integrating RITAs into routine surveillance and assisting with molecular genetic analyses, but evidence was generally weaker or only reported on what was done, without validation data or findings related to effectiveness of using non-incidence indicators calculated through the use of recency assays as a proxy for HIV incidence. Conclusions HIV recency assays have been widely validated for estimating HIV incidence in age- and sex-specific populations at national and subnational regional levels; however, there is a lack of evidence validating the accuracy and effectiveness of using recency assays to identify epidemic trends in non-incidence surveillance use cases. More research is needed to validate the use of recency assays within HIV testing services, to ensure findings can be accurately interpreted to guide prioritization of public health programming.

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Section: Resultsmentioning

confidence: 99%

Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review

Facente¹,

Grebe²,

Maher³

et al. 2022

JMIR Public Health Surveill

View full text Add to dashboard Cite

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“…Development of novel methods for estimating incidence is an active area of research [43][44][45][46]. Estimating HIV incidence requires the ability to identify who among newly diagnosed individuals are recently infected and estimate the proportion of recent infections that were diagnosed.…”

Section: Discussionmentioning

confidence: 99%

Assessing the reliability of the CD4 depletion model in the presence of ending the HIV epidemic initiatives

Tang

Goyal

Anderson

et al. 2023

Aids

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Background: Accurate estimates of HIV incidence are necessary to monitor progress towards Ending the HIV Epidemic (EHE) initiative targets (90% decline by 2030). U.S. incidence estimates are derived from a CD4 depletion model (CD4 model). We performed simulation-based analyses to investigate the ability of this model to estimate HIV incidence when implementing EHE interventions that have the potential to shorten the duration between HIV infection and diagnosis (diagnosis delay). Methods: Our simulation study evaluates the impact of three parameters on the accuracy of incidence estimates derived from the CD4 model: rate of HIV incidence decline, length of diagnosis delay, and sensitivity of using CD4+ cell counts to identify new infections (recency error). We model HIV incidence and diagnoses after the implementation of a theoretical prevention intervention and compare HIV incidence estimates derived from the CD4 model to simulated incidence. Results: Theoretical interventions that shortened the diagnosis delay (10–50%) result in overestimation of HIV incidence by the CD4 model (10–92%) in the first year and by more than 10% for the first 6 years after implementation of the intervention. Changes in the rate of HIV incidence decline and the presence of recency error had minimal impact on the accuracy of incidence estimates derived from the CD4 model. Conclusion: In the setting of EHE interventions to identify persons with HIV earlier during infection, the CD4 model overestimates HIV incidence. Alternative methods to estimate incidence based on objective measures of incidence are needed to assess and monitor EHE interventions.

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“…Monitoring HIV incidence allows identifying priority populations at high risk of HIV acquisition, essential information for planning interventions and evaluating public health programmes [1]. Biomarker-based assays that detect recent HIV seroconversions, defined as those that have occurred within 4-6 months of HIV infection, are increasingly used to identify ongoing transmission, monitor incidence changes, and identify population groups and geographic areas with higher relative infection levels [1][2][3][4][5][6][7]. These assays are often employed in recent infection testing algorithms (RITAs) that reclassify falserecent infections based on additional diagnostics, such as viral load, antiretroviral metabolites or other epidemiological information [1,[8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Inferring population HIV incidence trends from surveillance data of recent HIV infection among HIV testing clients

Godin

Eaton

Giguère

et al. 2021

Aids

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Background: Measuring recent HIV infections from routine surveillance systems could allow timely and granular monitoring of HIV incidence patterns. We evaluated the relationship of two recent infection indicators with alternative denominators to true incidence patterns. Methods: We used a mathematical model of HIV testing behaviours, calibrated to population-based surveys and HIV testing services programme data, to estimate the number of recent infections diagnosed annually from 2010 to 2019 in Côte d’Ivoire, Malawi, and Mozambique. We compared two different denominators to interpret recency data: those at risk of HIV acquisition (HIV-negative tests and recent infections) and all people testing HIV positive. Sex and age-specific longitudinal trends in both interpretations were then compared with modelled trends in HIV incidence, testing efforts and HIV positivity among HIV testing services clients. Results: Over 2010–2019, the annual proportion of the eligible population tested increased in all countries, while positivity decreased. The proportion of recent infections among those at risk of HIV acquisition decreased, similar to declines in HIV incidence among adults (≥15 years old). Conversely, the proportion of recent infections among HIV-positive tests increased. The female-to-male ratio of the proportion testing recent among those at risk was closer to 1 than the true incidence sex ratio. Conclusion: The proportion of recent infections among those at risk of HIV acquisition is more indicative of HIV incidence than the proportion among HIV-positive tests. However, interpreting the observed patterns as surrogate measures for incidence patterns may still be confounded by different HIV testing rates between population groups or over time.

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Cross-Sectional Human Immunodeficiency Virus Incidence Estimation Accounting for Heterogeneity Across Communities

Cited by 6 publications

References 21 publications

Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review

Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review

Assessing the reliability of the CD4 depletion model in the presence of ending the HIV epidemic initiatives

Inferring population HIV incidence trends from surveillance data of recent HIV infection among HIV testing clients

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