Estimating HIV Incidence among Adults in Kenya and Uganda: A Systematic Comparison of Multiple MethodsReportar como inadecuado

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Several approaches have been used for measuring HIV incidence in large areas, yet each presents specific challenges in incidence estimation.

Methodology-Principal Findings

We present a comparison of incidence estimates for Kenya and Uganda using multiple methods: 1 Epidemic Projections Package EPP and Spectrum models fitted to HIV prevalence from antenatal clinics ANC and national population-based surveys NPS in Kenya 2003, 2007 and Uganda 2004-2005; 2 a survey-derived model to infer age-specific incidence between two sequential NPS; 3 an assay-derived measurement in NPS using the BED IgG capture enzyme immunoassay, adjusted for misclassification using a locally derived false-recent rate FRR for the assay; 4 community cohorts in Uganda; 5 prevalence trends in young ANC attendees. EPP-Spectrum-derived and survey-derived modeled estimates were similar: 0.67 uncertainty range: 0.60, 0.74 and 0.6 confidence interval: CI 0.4, 0.9, respectively, for Uganda 2005 and 0.72 uncertainty range: 0.70, 0.74 and 0.7 CI 0.3, 1.1, respectively, for Kenya 2007. Using a local FRR, assay-derived incidence estimates were 0.3 CI 0.0, 0.9 for Uganda 2004-2005 and 0.6 CI 0, 1.3 for Kenya 2007. Incidence trends were similar for all methods for both Uganda and Kenya.


Triangulation of methods is recommended to determine best-supported estimates of incidence to guide programs. Assay-derived incidence estimates are sensitive to the level of the assay-s FRR, and uncertainty around high FRRs can significantly impact the validity of the estimate. Systematic evaluations of new and existing incidence assays are needed to the study the level, distribution, and determinants of the FRR to guide whether incidence assays can produce reliable estimates of national HIV incidence.

Autor: Andrea A. Kim , Timothy Hallett, John Stover, Eleanor Gouws, Joshua Musinguzi, Patrick K. Mureithi, Rebecca Bunnell, John Hargrov



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