Abstract
ObjectiveTo estimate HIV prevalence in adults who have not tested for HIV using age‐specific mortality rates and to adjust the overall population HIV prevalence to include both tested and untested adults.MethodsAn open cohort study was established since 1994 with demographic surveillance system (DSS) and five serological surveys conducted. Deaths from Kisesa DSS were used to estimate mortality rates and 95% confidence intervals by HIV status for 3‐ 5‐year periods (1995–1999, 2000–2004, and 2005–2009). Assuming that mortality rates in individuals who did not test for HIV are similar to those in tested individuals, and dependent on age, sex and HIV status and HIV, prevalence was estimated.ResultsIn 1995–1999, mortality rates (per 1000 person years) were 43.7 (95% CI 35.7–53.4) for HIV positive, 2.6 (95% CI 2.1–3.2) in HIV negative and 16.4 (95% CI 14.4–18.7) in untested. In 2000–2004, mortality rates were 43.3 (95% CI 36.2–51.9) in HIV positive, 3.3 (95% CI 2.8–4.0) in HIV negative and 11.9 (95% CI 10.5–13.6) in untested. In 2005–2009, mortality rates were 30.7 (95% CI 24.8–38.0) in HIV positive, 4.1 (95% CI 3.5–4.9) in HIV negative and 5.7 (95% CI 5.0–6.6) in untested residents. In the three survey periods (1995–1999, 2000–2004, 2005–2009), the adjusted period prevalences of HIV, including the untested, were 13.5%, 11.6% and 7.1%, compared with the observed prevalence in the tested of 6.0%, 6.8 and 8.0%. The estimated prevalence in the untested was 33.4%, 21.6% and 6.1% in the three survey periods.ConclusionThe simple model was able to estimate HIV prevalence where a DSS provided mortality data for untested residents.
Highlights
The number of people living with HIV worldwide in 2007 was estimated at 33.2 million, with subSaharan Africa (SSA) being the most affected region (WHO 2008)
Based on the observed mortality, our analysis showed, in the period from 1995 to 2004, residents who did not test for HIV had significantly higher period prevalence of HIV than residents who tested for HIV across both sexes and all age groups
This study has found poor participation in HIV testing among residents in Kisesa ward among males, and the proportion of residents testing maintained gradual decrease for each subsequent year of sero-survey
Summary
The number of people living with HIV worldwide in 2007 was estimated at 33.2 million, with subSaharan Africa (SSA) being the most affected region (WHO 2008). The advantage of using population-based surveys is that they provide reliable and nationally representative direct estimates of HIV prevalence in countries with generalised epidemics as well as understanding of the magnitude and spread of epidemics (Mishra et al 2008). Another advantage of populationbased surveys is that they can be a source of direct data on the distribution of HIV infection among different adult populations, men, women (pregnant & non-pregnant) and across different geographical regions (Mishra et al 2006)
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