Inferring HIV incidence from case surveillance with CD4+ cell counts

Jansson, James; Kerr, Cliff C; Mallitt, Kylie‐Ann; Wu, Jianyun; Gray, Richard T.; Wilson, David

doi:10.1097/qad.0000000000000679

Cited by 13 publications

(13 citation statements)

References 50 publications

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“…Our estimate of HIV prevalence falls between the self-reported 5% found in national household samples [ 2 , 3 ] and the 10% reported by GBM in larger cities [ 4 , 5 ]. Our estimate of undiagnosed HIV is considerably lower than that found in previous studies conducted at gay venues in Melbourne and Queensland [ 6 , 7 ] and slightly lower than that used in recent modelling of the Australian epidemic [ 8 , 9 ]. Internationally, our results indicate that undiagnosed HIV among Australian GBM is among the lowest seen in high-income countries with concentrated epidemics among GBM [ 11 – 15 ].…”

Section: Discussioncontrasting

confidence: 82%

“…Our study found a relatively low level of undiagnosed HIV among GBM in six Australian cities. The results suggest that recent modelling of the Australian epidemic may have slightly overestimated the burden of undiagnosed infection among GBM in metropolitan areas [ 8 , 9 ]. The profile of men with undiagnosed infection in our study highlights the ongoing need for HIV prevention and harm reduction programmes for GBM who have drug-based sex and condomless sex with casual partners.…”

Section: Discussionmentioning

confidence: 99%

“…These studies found that 9 to 10% of participants were HIV positive and 20 to 31% of HIV-positive GBM were unaware of their infection. Modelling of the Australian HIV epidemic has suggested that 9 to 12% of GBM with HIV are undiagnosed [ 8 – 10 ]. No prevalence studies have been conducted before in Australian cities with notable GBM populations like Sydney, Adelaide or Perth [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Holt

Lea

Asselin

et al. 2015

Journal of the International AIDS Society

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IntroductionGay and bisexual men (GBM) with undiagnosed HIV are believed to contribute disproportionately to HIV transmission in Australia but national prevalence estimates have been lacking.MethodsFrom November 2013 to November 2014, we recruited men at gay venues and events in six Australian states and territories. Of 7291 survey participants, 3071 men also provided an oral fluid sample for testing and decided whether to receive their test results or not. We calculated raw and population-weighted prevalence estimates and identified associations with undiagnosed infection using logistic regression.ResultsOf 3071 participants, 213 men tested HIV-positive (6.9%, 95% confidence interval [CI] 6.0 to 7.8%), of whom 19 (8.9%, 95% CI 5.8 to 13.5%) were previously undiagnosed. After weighting for the size of the gay and bisexual male population in each state or territory, national HIV prevalence was estimated to be 7.2% (95% CI 6.3 to 8.1), of which 9.1% (95% CI 6.0 to 13.6%) were estimated to be undiagnosed. Compared with HIV-negative participants, men with undiagnosed HIV were more likely to report meeting partners at sex venues, using antiretroviral drugs as pre-exposure prophylaxis, condomless anal intercourse with casual partners, using party drugs for sex, injecting drugs and using amyl nitrite, crystal methamphetamine or gamma hydroxybutyrate in the six months prior to the survey.DiscussionThe results indicate that the prevalence of undiagnosed HIV is relatively low among Australian GBM but is higher among men who report riskier sex and drug practices.ConclusionsThe results underline the importance of targeted HIV prevention and frequent testing for men at increased risk of infection.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Holt

Lea

Asselin

et al. 2015

Journal of the International AIDS Society

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“… * For example Jansson et al . [ 39 ] proposed back-calculation based on complete data set of CD4 count. …”

Section: Discussionmentioning

confidence: 99%

“…For example, a novel method developed by Jansson et al . [ 39 ] estimates incidence and prevalence, making use of the date and value of first-recorded CD4 count.…”

Section: Living With Hivmentioning

confidence: 99%

The HIV care cascade: a systematic review of data sources, methodology and comparability

Medland

McMahon

Chow

et al. 2015

Journal of the International AIDS Society

119

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IntroductionThe cascade of HIV diagnosis, care and treatment (HIV care cascade) is increasingly used to direct and evaluate interventions to increase population antiretroviral therapy (ART) coverage, a key component of treatment as prevention. The ability to compare cascades over time, sub-population, jurisdiction or country is important. However, differences in data sources and methodology used to construct the HIV care cascade might limit its comparability and ultimately its utility. Our aim was to review systematically the different methods used to estimate and report the HIV care cascade and their comparability.MethodsA search of published and unpublished literature through March 2015 was conducted. Cascades that reported the continuum of care from diagnosis to virological suppression in a demographically definable population were included. Data sources and methods of measurement or estimation were extracted. We defined the most comparable cascade elements as those that directly measured diagnosis or care from a population-based data set.Results and discussionsThirteen reports were included after screening 1631 records. The undiagnosed HIV-infected population was reported in seven cascades, each of which used different data sets and methods and could not be considered to be comparable. All 13 used mandatory HIV diagnosis notification systems to measure the diagnosed population. Population-based data sets, derived from clinical data or mandatory reporting of CD4 cell counts and viral load tests from all individuals, were used in 6 of 12 cascades reporting linkage, 6 of 13 reporting retention, 3 of 11 reporting ART and 6 of 13 cascades reporting virological suppression. Cascades with access to population-based data sets were able to directly measure cascade elements and are therefore comparable over time, place and sub-population. Other data sources and methods are less comparable.ConclusionsTo ensure comparability, countries wishing to accurately measure the cascade should utilize complete population-based data sets from clinical data from elements of a centralized healthcare setting, where available, or mandatory CD4 cell count and viral load test result reporting. Additionally, virological suppression should be presented both as percentage of diagnosed and percentage of estimated total HIV-infected population, until methods to calculate the latter have been standardized.

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How to Evolve the Response to the Global HIV Epidemic With New Metrics and Targets Based on Pre-Treatment CD4 Counts

Nash

Robertson

2019

Curr HIV/AIDS Rep

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Inferring HIV incidence from case surveillance with CD4+ cell counts

Abstract: This methodology provides a novel way of estimating population incidence by combining diagnosis dates and CD4 cell counts at diagnosis.

Cited by 13 publications

References 50 publications

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

The HIV care cascade: a systematic review of data sources, methodology and comparability

How to Evolve the Response to the Global HIV Epidemic With New Metrics and Targets Based on Pre-Treatment CD4 Counts

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