Estimating HIV Incidence Using a Cross-Sectional Survey: Comparison of Three Approaches in a Hyperendemic Setting, Ndhiwa Subcounty, Kenya, 2012

BlaizotStéphanie,; KimAndrea, A; ZehClement,; RicheBenjamin,; Maman, David; CockKevin, M De; EtardJean-François,; EcochardRené,

doi:10.1089/aid.2016.0123

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…Most estimates were drawn from prospective studies (45 [88%] of 51 studies), with cohort data from observational research or intervention trials, while six (12%) studies estimated recent HIV infection among HIVpositive samples from cross-sectional surveys. 7,21,22,33,40,42 The cohort studies estimated incidence from repeated observations, most often imputing the timing of seroconversion from the midpoint or a random-point between the latest-negative and earliest-positive antibody test dates. Details of statistical methods for estimation were not always available or consistently reported across studies.…”

Section: Resultsmentioning

confidence: 99%

“…Ruzagira et al (2011) 14 Okiria et al (2014) 35 Borgdorff et al (2018) 20 , Birdthistle et al (2018) 19 Biraro et al (2013) 36 Santelli et al (2015) 39 Santelli et al (2013) 38 Grabowski et al (2017) 37 Grabowski et al (2017) 37 Santelli et al (2015) 38 Blaizot et al (2017) 21 Blaizot et al (2017) 21 Geis et al (2011) 34…”

Section: Female Subgroupmentioning

confidence: 99%

“…Blaizot et al (2017) 21 Okiria et al (2014) 35 Blaizot et al (2017) 21 Borgdorff et al (2018) 20 , Birdthistle et al (2018) 19 Grabowski et al (2017) 37 Biraro et al (2013) 36 Santelli et al (2015) 39 Grabowski et al (2017) 37 Santelli et al (2013) 38 Santelli et al (2015) 39 Geis et al (2011) 34 largely limited to a small number of surveillance sites or relatively small observational and intervention studies with high-risk groups.…”

Section: Male Subgroupmentioning

confidence: 99%

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Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

Birdthistle

Tanton

Tomita

et al. 2019

The Lancet Global Health

145

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Background The roll-out of antiretroviral therapy (ART) has changed contexts of HIV risk, but the influence on HIV incidence among young women is not clear. We aimed to summarise direct estimates of HIV incidence among adolescent girls and young women since ART and before large investments in targeted prevention for those in sub-Saharan Africa.Methods We did a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, Global Health, and CINAHL for studies reporting HIV incidence data from serological samples collected among females aged 15-24 years in ten countries (

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Section: Resultsmentioning

confidence: 99%

Section: Female Subgroupmentioning

confidence: 99%

Section: Male Subgroupmentioning

confidence: 99%

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Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

Birdthistle

Tanton

Tomita

et al. 2019

The Lancet Global Health

145

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“…In a previous community‐randomized study, the primary HIV incidence endpoint was determined by analysing samples collected in a cross‐sectional survey of > 46,000 individuals . In that study, the testing algorithm used for cross‐sectional HIV incidence estimation included viral load as a biomarker for non‐recent infection ; low viral load is also used as a biomarker for non‐recent infection in an algorithm that is widely used for cross‐sectional HIV incidence estimation in surveillance studies . Further studies are needed to assess the performance of these algorithms in settings where ART is initiated early in HIV infection since individuals with recent infection who are virally suppressed from ART would be misclassified as having non‐recent infection.…”

Section: Discussionmentioning

confidence: 99%

Determination of HIV status and identification of incident HIV infections in a large, community‐randomized trial: HPTN 071 (PopART)

et al. 2020

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Introduction The HPTN 071 (PopART) trial evaluated the impact of an HIV combination prevention package that included “universal testing and treatment” on HIV incidence in 21 communities in Zambia and South Africa during 2013‐2018. The primary study endpoint was based on the results of laboratory‐based HIV testing for> 48,000 participants who were followed for up to three years. This report evaluated the performance of HIV assays and algorithms used to determine HIV status and identify incident HIV infections in HPTN 071, and assessed the impact of errors on HIV incidence estimates. Methods HIV status was determined using a streamlined, algorithmic approach. A single HIV screening test was performed at centralized laboratories in Zambia and South Africa (all participants, all visits). Additional testing was performed at the HPTN Laboratory Center using antigen/antibody screening tests, a discriminatory test and an HIV RNA test. This testing was performed to investigate cases with discordant test results and confirm incident HIV infections. Results HIV testing identified 978 seroconverter cases. This included 28 cases where the participant had acute HIV infection at the first HIV‐positive visit. Investigations of cases with discordant test results identified cases where there was a participant or sample error (mixups). Seroreverter cases (errors where status changed from HIV infected to HIV uninfected, 0.4% of all cases) were excluded from the primary endpoint analysis. Statistical analysis demonstrated that exclusion of those cases improved the accuracy of HIV incidence estimates. Conclusions This report demonstrates that the streamlined, algorithmic approach effectively identified HIV infections in this large cluster‐randomized trial. Longitudinal HIV testing (all participants, all visits) and quality control testing provided useful data on the frequency of errors and provided more accurate data for HIV incidence estimates.

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“…The EQAPOL LAg EQA program, which is jointly managed by Duke University and Vitalant Research Institute and is supported by the NIH/NIAID, has successfully launched an international EQA/proficiency testing program for the HIV-1 LAg assay. The assays utilized in this program are CDC-approved and widely employed globally to classify HIV infections as recently acquired or longstanding for the purposes of cross-sectionally estimating incidence in population-level studies [22–25]. Increasingly, expanded use-cases for individual-level infection staging and improved estimation of individual time of infection (in combination of diagnostic test results) are being contemplated and piloted.…”

Section: Discussionmentioning

confidence: 99%

Development of an international external quality assurance program for HIV-1 incidence using the Limiting Antigen Avidity assay

et al. 2019

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Laboratory assays for identifying recent HIV-1 infections are widely used for estimating incidence in cross-sectional population-level surveys in global HIV-1surveillance. Adequate assay and laboratory performance are required to ensure accurate incidence estimates. The NIAID-supported External Quality Assurance Program Oversight Laboratory (EQAPOL) established a proficiency testing program for the most widely-used incidence assay, the HIV-1 Limiting Antigen Avidity EIA (LAg), with US Centers for Disease Control and Prevention (CDC)-approved kits manufactured by Sedia Biosciences Corporation and Maxim Biomedical. The objective of this program is to monitor the performance of participating laboratories. Four rounds of blinded external proficiency (EP) panels were distributed to up to twenty testing sites (7 North American, 5 African, 4 Asian, 2 South American and 2 European). These panels consisted of ten plasma samples: three blinded well-characterized HIV-1-seropositive samples that were included as replicates and an HIV-negative control. The seropositive samples spanned the dynamic range of the assay and are categorized as either recent or long-term infection. Participating sites performed the assay according to manufacturers’ instructions and completed an online survey to gather information on kit manufacturer, lot of kit used, laboratory procedures and the experience of technicians. On average, fifteen sites participated in each round of testing, with an average of four sites testing with only the Maxim assay, seven testing with only the Sedia assay and five sites utilizing both assays. Overall, the Sedia and Maxim assays yielded similar infection status categorization across the laboratories; however, for most of the nine HIV+ samples tested, there were significant differences in the optical density readouts, ODn (N = 8) and OD (N = 7), between LAg kit manufacturers (p < 0.05 based on mixed effects models. The EQAPOL LAg program is important for monitoring laboratory performance as well as detecting variations between manufacturers of HIV-1incidence assays.

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Estimating HIV Incidence Using a Cross-Sectional Survey: Comparison of Three Approaches in a Hyperendemic Setting, Ndhiwa Subcounty, Kenya, 2012

Cited by 5 publications

References 30 publications

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

Determination of HIV status and identification of incident HIV infections in a large, community‐randomized trial: HPTN 071 (PopART)

Development of an international external quality assurance program for HIV-1 incidence using the Limiting Antigen Avidity assay

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