Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa

Abstract

Background: To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population.

High HIV Prevalence and Associated Factors in a Remote Community in the Rwenzori Region of Western Uganda

“…The same age pattern differences have been reported previously and were attributed to poor representation and self-selection of ANC/PMTCT clients. [47][48][49] Although anonymous ANC HIV sero-surveillance has been previously used to monitor HIV sero-prevalence in the general population, [50][51][52][53] integrated ANC/PMTCT re-enforces selection bias as some mothers are likely to stay away for fear of being tested for HIV, thus making ANC/PMTCT data unsuitable for monitoring HIV prevalence in the general population. Previous studies have established that those refusing to test are often at a higher risk of HIV infection than those who consent.…”

Implications of and perspectives on HIV surveillance using a serological method to measure recent HIV infections in newly diagnosed individuals: results from a pilot study in Berlin, Germany, in 2005–2007

“…An appropriate design, however, will allow valid incidence estimations, especially in the context of population-based HIV surveillance, such as that recently reported from South Africa [14]. Population-based and antenatal care HIV surveillance is appropriate and feasible in regions with generalized epidemics such as southern African countries [34]. This is not the case in countries with concentrated epidemics such as Germany, where the denominators of the subpopulations at increased risk are difficult to obtain, a fact making general incidence estimations inaccurate or even impossible to acquire.…”

Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa

“…Third, the prevalence of HIV infection measured through antenatal surveillance has not declined since the late 1990s, 36 the current population incidence rate of HIV infection is high, 37 and the prevalence of HIV infection in the study community has increased steadily. 16,17 Thus, it is unlikely that the observed decrease in overall population mortality is the late result of a sudden decline in the incidence of HIV infection.…”