Underestimation of HIV prevalence in surveys when some people already know their status, and ways to reduce the bias

Floyd, Sian; Molesworth, Anna; Dube, Albert; Crampin, Amelia C.; Houben, Rein M. G. J.; Chihana, Menard; Price, Alison; Kayuni, Ndoliwe; Saul, Jacqueline; French, Neil; Glynn, Judith R.

doi:10.1097/qad.0b013e32835848ab

Cited by 51 publications

(57 citation statements)

References 16 publications

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“…To test the robustness of our findings, we conducted additional analyses using methods similar to those introduced by Floyd et al [20]. We added HIV status data available at one point in time from the same individual who at another point in time refused an HIV test to proxy HIV status at the date of refusal.…”

Section: Resultsmentioning

confidence: 99%

Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment

Zaidi

Grapsa

Tanser

et al. 2013

Aids

142

124

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Objectives To investigate HIV prevalence trends in a rural South African community after the scale-up of antiretroviral treatment (ART) in 2004. Methods We estimated adult HIV prevalence (ages 15–49 years) using data from a large, longitudinal, population-based HIV surveillance in rural KwaZulu-Natal, South Africa, over the period from 2004 (the year when the public-sector ART scale-up started) through 2011. We control for selection effects due to surveillance non-participation using multiple imputation. We further linked the surveillance data to patient records from the local HIV treatment programme to estimate ART coverage. Results ART coverage of all HIV-infected people in this community increased from 0% in 2004 to 31% in 2011. Over the same observation period adult HIV prevalence increased steadily from 21% to 29%. The overall increase in HIV prevalence was largely driven by the prevalence trends in women and men older than 24 years of age, i.e., the age group in which the largest proportions of HIV-infected people received ART. Conclusions The observed dramatic rise in adult HIV prevalence can be largely explained by increased survival of HIV-infected people due to ART. This interpretation is supported by the fact that the overall HIV prevalence trend is mostly due to increases in prevalence in older adults, i.e., in the age groups that currently benefit most from the local ART scale-up. Future studies should decompose HIV prevalence trends into HIV incidence and HIV-specific mortality changes to further improve the causal attribution of prevalence increases to treatment success rather than prevention failure.

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Section: Resultsmentioning

confidence: 99%

Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment

Zaidi

Grapsa

Tanser

et al. 2013

Aids

142

124

View full text Add to dashboard Cite

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“…Four annual HIV serosurveys (2007–2011), with 70% participation and 98% requesting their results, show HIV prevalence is 9% in adult women 6. Trained local key informants (n=280) provide notification of all births (including stillbirths) in the DSS on a monthly basis, and the date and location of each birth and the parent's details are recorded at a home visit from a study interviewer.…”

Section: Methodsmentioning

confidence: 99%

Uptake of prevention of mother-to-child-transmission using Option B+ in northern rural Malawi: a retrospective cohort study

et al. 2014

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To identify points of dropout on the pathway from offering HIV testing to maintenance on antiretroviral therapy (ART), following the introduction of the Option B+ policy for pregnant women in Malawi (lifelong ART for HIV-positive mothers and 6 weeks nevirapine for the infants), a retrospective cohort study within a demographic surveillance system in northern Malawi. Women living in the demographic surveillance system who initiated antenatal care (ANC) between July 2011 (date of policy change) and January 2013, were eligible for inclusion. Women who consented were interviewed at home about their health facility attendance and care since pregnancy, including antenatal clinic (ANC) visits, delivery and postpartum care. Women's reports, patient-held health records and clinic health records were manually linked to ascertain service use. Among 395 women, 86% had tested for HIV before the pregnancy, 90% tested or re-tested at the ANC visit, and <1% had never tested. Among 53 mothers known to be HIV-positive before attending ANC, 15 (28%) were already on ART prior to pregnancy. Ten women tested HIV-positive for the first time during pregnancy. Of the 47 HIV-positive mothers not already on ART, 26/47 (55%) started treatment during pregnancy. All but five women who started ART were still on treatment at the time of study interview. HIV testing was almost universal and most women who initiated ART were retained in care. However, nearly half of eligible pregnant women not on ART at the start of ANC had not taken up the invitation to initiate (lifelong) ART by the time of delivery, leaving their infants potentially HIV-exposed.

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“…The Manicaland study offered free HIV tests for diagnostic purposes at a local antenatal clinic. Some of the ALPHA Network members have published studies describing the HIV serosurveys, non-response in the HIV serosurveillance and associated bias in HIV prevalence estimates 21–25. The serosurveys also create an opportunity to administer an individual interview on sexual behaviour, health services utilization, etc.…”

Section: Data Collectedmentioning

confidence: 99%

Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)

et al. 2016

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Summary The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network, http://alpha.lshtm.ac.uk/) brings together ten population-based HIV surveillance sites in eastern and southern Africa, and is coordinated by the London School of Hygiene and Tropical Medicine (LSHTM). It was established in 2005 and aims to (i) broaden the evidence base on HIV epidemiology for informing policy, (ii) strengthen the analytical capacity for HIV research, and (iii) foster collaboration between network members. All study sites, some starting in the late 1980s and early 1990s, conduct demographic surveillance in populations that range from approximately 20 to 220 thousand individuals. In addition, they conduct population-based surveys with HIV testing, and verbal autopsy interviews with relatives of deceased residents. ALPHA Network datasets have been used for studying HIV incidence, sexual behaviour and the effects of HIV on mortality, fertility, and household composition. One of the network's substantive focus areas is the monitoring of AIDS mortality and HIV services coverage in the era of antiretroviral therapy. Service use data are retrospectively recorded in interviews and supplemented by information from record linkage with medical facilities in the surveillance areas. Data access is at the discretion of each of the participating sites, but can be coordinated by the network.

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Underestimation of HIV prevalence in surveys when some people already know their status, and ways to reduce the bias

Cited by 51 publications

References 16 publications

Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment

Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment

Uptake of prevention of mother-to-child-transmission using Option B+ in northern rural Malawi: a retrospective cohort study

Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)

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