Abstract
BackgroundNational or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making. Health facility programme data, collected during service delivery is widely available, but since people self-select for HIV testing, HIV prevalence estimates based on it, is subject to selection bias. We present a statistical annealing technique, Hybrid Prevalence Estimation (HPE), that combines a small population-based survey sample with a facility-based sample to generate district level HIV prevalence estimates with associated confidence intervals.MethodsWe apply the HPE methodology to combine the 2011 Uganda AIDS indicator survey with the 2011 health facility HIV testing data to obtain HIV prevalence estimates for districts in Uganda. Multilevel logistic regression was used to obtain the propensity of testing for HIV in a health facility, and the propensity to test was used to combine the population survey and health facility HIV testing data to obtain the HPEs. We assessed comparability of the HPEs and survey-based estimates using Bland Altman analysis.ResultsThe estimates ranged from 0.012 to 0.178 and had narrower confidence intervals compared to survey-based estimates. The average difference between HPEs and population survey estimates was 0.00 (95% CI: − 0.04, 0.04). The HPE standard errors were 28.9% (95% CI: 23.4–34.4) reduced, compared to survey-based standard errors. Overall reduction in HPE standard errors compared survey-based standard errors ranged from 5.4 to 95%.ConclusionsFacility data can be combined with population survey data to obtain more accurate HIV prevalence estimates for geographical areas with small population survey sample sizes. We recommend use of the methodology by district level managers to obtain more accurate HIV prevalence estimates to guide decision making without incurring additional data collection costs.
Highlights
National or regional population-based Human Immunodeficiency Virus (HIV) prevalence surveys have small sample sizes at district or sub-district levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making
Uganda AIDS Indicator Survey (UAIS) data was downloaded from the Measure Demographic Health Survey (DHS) website www.measuredhs.com after obtaining consent from ICF/Macro international, while health facility testing data was extracted from the District Health Information System Version 2 (DHIS2) hosted at Ministry of Health (MoH) after obtaining written permission from MoH
HIV prevalence among those who tested in a health facility was 0.084 compared to 0.068 among those who did not test in a health facility (Table 1)
Summary
National or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making. The surveys are designed to provide estimates at national and regional levels, but small sample sizes at district or sub-district levels lead to less reliable indicator estimates, that have wider confidence intervals [1,2,3,4]. Health Information Systems such as the District Health Information System (DHIS2) provide another source of information that can be used for monitoring the HIV/ AIDS epidemic This data is collected more regularly, available at more decentralized levels, e.g. districts and costs less to collect. Routine service delivery data are collected only on individuals who attend/access health facilities and provide potentially biased estimates of population indicators
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