Estimating the HIV incidence rate: recent and future developments

Abstract

To describe the needs for information on the rate of new HIV infections (incidence) in epidemics and review developments in various methods for its estimation. Epidemiological methods for estimating incidence with models using prevalence data have been useful, but the expansion of antiretroviral treatment programmes could now challenge their reliability. Laboratory-based HIV incidence assays that can be used to measure HIV incidence using a cross-sectional survey, provide a promising concept, but current technologies have not been sufficiently accurate. New statistical methods have been developed that show that if the properties of the assay are properly measured then unbiased estimates of incidence can be derived, and that assays meeting certain criteria can produce estimates of acceptable accuracy and precision. Encouragingly, some new assays and algorithms show signs of potentially meeting those criteria. Among the next challenges will be the systematic evaluation of assay performance in many different types of specimen and the validation of those methods through comparison with other measurements of incidence. Recent developments in epidemiological and incidence assay-based methods of measuring incidence have been substantial and are likely to eventually lead to a revolution in the way that worldwide HIV epidemics are routinely tracked.