Is the HIV burden in India being overestimated?

Dandona, Lalit; Lakshmi, V; Kumar, G Anil; Dandona, Rakhi

doi:10.1186/1471-2458-6-308

Cited by 26 publications

(23 citation statements)

References 7 publications

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“…Nonetheless, data collection is generally performed through prenatal health services, considered sentinel sites, and nonrandom selection of health establishments can substantially affect results. In India, HIV prevalence found in a populationbased study was much lower than that obtained through a sentinel study of prenatal clinics [11]. On the other hand, incomplete coverage of the sentinel network in African countries, which fail to reach rural and remote areas, can underestimate HIV prevalence in these countries [12].…”

mentioning

confidence: 84%

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil

Cl¹,

A²,

Pr³

et al. 2008

Braz J Infect Dis

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This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (<50,000; 50,000-399,999; 400,000+). In the second stage, 100-120 women were selected systematically. Data collection was based on HIV-test results registered in pre-natal cards and in hospital records. The analysis focused on coverage of HIV-testing during pregnancy and HIV prevalence rate. Logistic regression models were used to test inequalities in HIV-testing coverage during pregnancy by macro-region of residence, municipality size, race, educational level and age group. The study included 16,158 women. Results were consistent with previous studies based on primary data collection. Among the women receiving pre-natal care with HIV-test results registered in their pre-natal cards, HIV prevalence was 0.41%. Coverage of HIV-testing during pregnancy was 62.3% in the country as a whole, but ranged from 40.6% in the Northeast to 85.8% in the South. Significant differences according to race, educational level and municipality size were also found. The proposed methodology is low-cost, easy to apply, and permits identification of problems in routine service provision, in addition to monitoring compliance with Ministry of Health recommendations for pre-natal care.

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mentioning

confidence: 84%

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil

Cl¹,

A²,

Pr³

et al. 2008

Braz J Infect Dis

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“…Four hundred ANC attenders from each of the two ANC in all of Karnataka's 27 districts were sampled each year between 2003 and 2007 inclusive. Although it has been suggested that HIV prevalence among ANC attenders in India may overestimate HIV prevalence in the general population [17], the fact that the same sites and populations were sampled over a period of many years allows for an examination of trends over time [18].…”

Section: Methodsmentioning

confidence: 99%

Impact of an intensive HIV prevention programme for female sex workers on HIV prevalence among antenatal clinic attenders in Karnataka state, south India: an ecological analysis

Moses

Ramesh

Nagelkerke

et al. 2008

Aids

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Although this analysis is limited by lack of precise comparative data on intervention coverage and intensity, it supports the notion that scaled-up, intensive, targeted HIV preventive interventions among high-risk groups can have a measurable and relatively rapid impact on HIV transmission in the general population, particularly young sexually active populations as represented by ANC attenders. Such focused intervention programmes should be rapidly taken to scale in all HIV epidemics, and especially in concentrated epidemics such as in India.

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“…Most HSS-ANC sites are located in and around urban district headquarters, and coverage of rural areas, where more than 70% of the population reside [10], is limited. In fact, as in other countries [11], studies in India have shown that HSS-ANC sites overestimate HIV prevalence in the general population [12], [13]. Second, because of the limited number of sites in each district (generally two), analysis of HIV prevalence at the sub-district level is not possible.…”

Section: Introductionmentioning

confidence: 96%

Prevention of Parent to Child Transmission (PPTCT) Program Data in India: An Emerging Data Set for Appraising the HIV Epidemic

Sgaier¹,

Gupta

Rao

et al. 2012

PLoS ONE

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BackgroundEvidence based resource allocation and decentralized planning of an effective HIV/AIDS response requires reliable information on levels and trends of HIV at national and sub-national geographic levels. HIV sentinel surveillance data from antenatal clinics (HSS-ANC) has been an important data source to assess the HIV/AIDS epidemic in India, but has a number of limitations. We assess the value of Prevention of Parent to Child Transmission (PPTCT) programme data to appraise the HIV epidemic in India.Methods/FindingsHIV data from PPTCT sites were compared to HSS-ANC and general population level surveys at various geographic levels in the states of Karnataka, Maharashtra and Andhra Pradesh. Chi-square tests were used to ascertain statistical significance. PPTCT HIV prevalence was significantly lower than HSS-ANC HIV prevalence (0.92% vs. 1.22% in Andhra Pradesh, 0.65% vs. 0.89% in Karnataka, 0.52% vs. 0.60% in Maharashtra, p<0.001 for all three states). In all three states, HIV prevalence from PPTCT centres that were part of the sentinel surveillance was comparable to HSS-ANC prevalence but significantly higher than PPTCT centres that were not part of the sentinel surveillance. HIV prevalence from PPTCT data was comparable to that from general population surveys. In all three states, significant declines in HIV prevalence between 2007 and 2010 were observed with the PPTCT data set. District level analyses of HIV trends and sub-district level analysis of HIV prevalence were possible using the PPTCT and not the HSS-ANC data sets.ConclusionHIV prevalence from PPTCT may be a better proxy for general population prevalence than HSS-ANC. PPTCT data allow for analysis of HIV prevalence and trends at smaller geographic units, which is important for decentralized planning of HIV/AIDS programming. With further improvements to the system, India could replace its HSS-ANC with PPTCT programme data for surveillance.

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Is the HIV burden in India being overestimated?

Cited by 26 publications

References 7 publications

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil

Impact of an intensive HIV prevention programme for female sex workers on HIV prevalence among antenatal clinic attenders in Karnataka state, south India: an ecological analysis

Prevention of Parent to Child Transmission (PPTCT) Program Data in India: An Emerging Data Set for Appraising the HIV Epidemic

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