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

Godin, Arnaud; Eaton, Jeffrey W.; Giguère, Katia; Marsh, Kimberly; Lf, Johnson; Jahn, Andreas; Mbofana, Francisco; Ehui, E.; Maheu‐Giroux, Mathieu

doi:10.1097/qad.0000000000003021

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…Although Blantyre district had a lower percentage of recent infections among new HIV diagnoses (2.4%) than did the overall analysis population percentage (3.3%), geospatial analysis identified hotspots with significantly higher rates of recent infection that might have otherwise gone unrecognized. This supports the importance of using the number of recent infections in the numerator and total recent infections plus total negative HIV tests (total at risk) in the denominator to identify hotspots of increased transmission (9). In addition, triangulation of various surveillance data sources and indicators of recent infection is important to understand the true prevalence and transmission of HIV across time and space.…”

Section: Discussionmentioning

confidence: 76%

Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

Telford¹,

Tessema²,

Msukwa³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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Section: Discussionmentioning

confidence: 76%

Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

Telford¹,

Tessema²,

Msukwa³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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“…In this comparison, the authors found that recency indicators calculated as the [number of recent results]/[number of HIV-positive tests]—as is commonly used among the studies contained in this review—was not, in fact, a satisfactory proxy for HIV incidence, and in some cases even resulted in identifying temporal trends in an opposite direction from the incidence trend. Godin et al [ 181 ] suggested that estimating the proportion recent as the [number of recent results]/[number of people at risk for HIV acquisition] was more indicative of incidence trends; however, this method of calculating recency in non-incidence use cases was not reported by any of the studies or programs found in our review.…”

Section: Discussionmentioning

confidence: 77%

“…In the meantime, while already in wide use, use of recency assays for non-incidence use cases remains questionable. Godin and colleagues [ 181 ] recently presented results of a simulation analysis to compare the accuracy of various HIV recency indicators as a proxy for incidence, using different denominators for the proportions calculated. (As they did not report any original recency testing results, this paper was not eligible for inclusion in this review.)…”

Section: Discussionmentioning

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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“…In this comparison, the authors found that recency indicators calculated as the [number of recent results]/[number of HIV-positive tests]-as is commonly used among the studies contained in this review-was not, in fact, a satisfactory proxy for HIV incidence, and in some cases even resulted in identifying temporal trends in an opposite direction from the incidence trend. Godin et al [181] suggested that estimating the proportion recent as the [number of recent results]/[number of people at risk for HIV acquisition] was more indicative of incidence trends; however, this method of calculating recency in non-incidence use cases was not reported by any of the studies or programs found in our review. There were 24 analyses included in this review that assessed predictors or correlates of recent infection.…”

Section: Principal Findingsmentioning

confidence: 75%

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

Facente¹,

Grebe²,

Maher³

et al. 2021

Preprint

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

Cited by 8 publications

References 25 publications

Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

Geospatial Transmission Hotspots of Recent HIV Infection — Malawi, October 2019–March 2020

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 (Preprint)

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