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Estimating HIV Incidence among Adults in Kenya and Uganda: A Systematic Comparison of Multiple Methods

Author

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  • Andrea A Kim
  • Timothy Hallett
  • John Stover
  • Eleanor Gouws
  • Joshua Musinguzi
  • Patrick K Mureithi
  • Rebecca Bunnell
  • John Hargrove
  • Jonathan Mermin
  • Reinhard K Kaiser
  • Anne Barsigo
  • Peter D Ghys

Abstract

Background: 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. Conclusions/Significance: 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.

Suggested Citation

  • Andrea A Kim & Timothy Hallett & John Stover & Eleanor Gouws & Joshua Musinguzi & Patrick K Mureithi & Rebecca Bunnell & John Hargrove & Jonathan Mermin & Reinhard K Kaiser & Anne Barsigo & Peter D Gh, 2011. "Estimating HIV Incidence among Adults in Kenya and Uganda: A Systematic Comparison of Multiple Methods," PLOS ONE, Public Library of Science, vol. 6(3), pages 1-9, March.
    • Handle: RePEc:plo:pone00:0017535
    DOI: 10.1371/journal.pone.0017535
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    References listed on IDEAS

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    1. David Guwatudde & Fred Wabwire-Mangen & Leigh Anne Eller & Michael Eller & Francine McCutchan & Hannah Kibuuka & Monica Millard & Nelson Sewankambo & David Serwadda & Nelson Michael & Merlin Robb & th, 2009. "Relatively Low HIV Infection Rates in Rural Uganda, but with High Potential for a Rise: A Cohort Study in Kayunga District, Uganda," PLOS ONE, Public Library of Science, vol. 4(1), pages 1-8, January.
    2. Timothy B Hallett & Basia Zaba & Jim Todd & Ben Lopman & Wambura Mwita & Sam Biraro & Simon Gregson & J Ties Boerma & on behalf of the ALPHA Network, 2008. "Estimating Incidence from Prevalence in Generalised HIV Epidemics: Methods and Validation," PLOS Medicine, Public Library of Science, vol. 5(4), pages 1-12, April.
    3. Till Bärnighausen & Claudia Wallrauch & Alex Welte & Thomas A McWalter & Nhlanhla Mbizana & Johannes Viljoen & Natalie Graham & Frank Tanser & Adrian Puren & Marie-Louise Newell, 2008. "HIV Incidence in Rural South Africa: Comparison of Estimates from Longitudinal Surveillance and Cross-Sectional cBED Assay Testing," PLOS ONE, Public Library of Science, vol. 3(11), pages 1-8, November.
    4. Thomas M Rehle & Timothy B Hallett & Olive Shisana & Victoria Pillay-van Wyk & Khangelani Zuma & Henri Carrara & Sean Jooste, 2010. "A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-8, June.
    5. Carel Pretorius & John Stover & Lori Bollinger & Nicolas Bacaër & Brian Williams, 2010. "Evaluating the Cost-Effectiveness of Pre-Exposure Prophylaxis (PrEP) and Its Impact on HIV-1 Transmission in South Africa," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-10, November.
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