Estimating HIV incidence in populations using tests for recent infection: issues, challenges and the way forward
OUTPUT TYPE: Journal Article
PUBLICATION YEAR: 2010
TITLE AUTHOR(S): T.D.Mastro, A.A.Kim, THallett, T.Rehle, A.Welte, O.Laeyendecker, T.Oluoch, J.M.Garcia-Calleja
KEYWORDS: HIV TESTING AND COUNSELLING (HTC), HIV/AIDS
DEPARTMENT: Public Health, Societies and Belonging (HSC)
Print: HSRC Library: shelf number 6589
HANDLE: 20.500.11910/4026
URI: http://hdl.handle.net/20.500.11910/4026
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at researchoutputs@hsrc.ac.za.
Abstract
HIV incidence is the rate of new infections in a population over time. HIV incidence is a critical indicator needed to assess the status and trends of the HIV epidemic in populations and guide and assess the impact of prevention interventions. Methods: Several methods exist for estimating population-level HIV incidence: direct observation of HIV incidence through longitudinal follow-up of persons at risk for new HIV infection, indirect measurement of HIV incidence using data on HIV prevalence and mortality in a population, and direct measurement of HIV incidence through use of tests for recent infection (TRIs) that can differentiate "recent" from "non-recent" infections based on biomarkers in cross-sectional specimens. Given the limitations in measuring directly observed incidence and the assumptions needed for indirect measurements of incidence, there is an increasing demand for TRIs for HIV incidence surveillance and program monitoring and evaluation purposes. Results: Over ten years since the introduction of the first TRI, a number of low-, middle-, and high-income countries have integrated this method into their HIV surveillance systems to monitor HIV incidence in the population. However, the accuracy of these assays for measuring HIV incidence has been unsatisfactory to date, mainly due to misclassification of chronic infections as recent infection on the assay. To improve the accuracy of TRIs for measuring incidence, countries are recommended to apply case-based adjustments, formula-based adjustments using local correction factors, or laboratory-based adjustment to minimize error related to assay misclassification. Multiple tests may be used in a recent infection testing algorithm (RITA) to obtain more accurate HIV incidence estimates. Conclusion: There continues to be a high demand for improved TRIs and RITAs to monitor HIV incidence, determine prevention priorities, and assess impact of interventions. Current TRIs have noted limitations, but with appropriate adjustments, interpreted in parallel with other epidemiologic data, may still provide useful information on new infections in a population. New TRIs and RITAs with improved accuracy and performance are needed and development of these tools should be supported.-
Related Research Outputs:
- The development of harmonized minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region: assessment report on HTC policy reviews
- Regional minimum standards for guidance on HIV testing and counselling (HTC) in the SADC region
- Factors determining prenatal HIV testing for prevention of Mother to Child Transmission of HIV in Mpumalanga, South Africa
- Using participatory mapping to inform a community-randomized trial of HIV counseling and testing
- Lay counsellor-based risk reduction intervention with HIV negative diagnosed patients at HIV counselling and testing sites in a rural South African setting
- Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review
- Approaches to HIV counselling and testing: strengths and weaknesses, and challenges for the way forward
- Routine HIV testing (RHT) and its implications for the socio-economic right of access to health care in South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Mauritius
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Zambia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Namibia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Lesotho
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Namibia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: South Africa
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Zambia
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Lesotho
- The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: HTC country report: Mauritius
- Voluntary Counselling and Testing (VCT) site-based brief HIV behavioural risk reduction counselling for HIV negative and HIV positive clients at HIV counselling and testing sites in Mpumalanga, South Africa
- Substance use and HIV risk among HIV infected and uninfected Voluntary Counselling and Testing (VCT) clients in Gert Sibande district, South Africa