Abstract
Tests for recent infection (TRIs), such as the BED assay, provide a convenient way to estimate HIV incidence rates from cross-sectional survey data. Controversy has arisen over how the imperfect performance of a TRI should be characterised and taken into account. Recent theoretical work is providing a unified framework within which to work with a variety of TRI- and epidemic-specific assumptions in order to estimate incidence using imperfect TRIs, but suggests that larger survey sample sizes will be required than previously thought. This paper reviews the framework qualitatively and provides examples of estimator performance, identifying the characteristics required by a TRI to estimate incidence reliably that should guide the future development of TRIs.
Highlights
When monitoring HIV epidemics it is vital to estimate incidence in order to plan and evaluate HIV programmes [1]
The use of prevalence data in conjunction with mathematical modelling is an alternative approach [2,3], but is indirect and requires accurate knowledge of mortality and migration. The disadvantages of these methods have focused attention on estimating incidence from crosssectional surveys [4,5,6,7,8], with the result that a number of assays and algorithms that test for recent infection have been developed [9,10]
We provide a summary of the framework and explore its implications for the analysis of surveys and development of new test for recent infection’ (TRI)
Summary
When monitoring HIV epidemics it is vital to estimate incidence in order to plan and evaluate HIV programmes [1]. The use of prevalence data in conjunction with mathematical modelling is an alternative approach [2,3], but is indirect and requires accurate knowledge of mortality and migration The disadvantages of these methods have focused attention on estimating incidence from crosssectional surveys [4,5,6,7,8], with the result that a number of assays and algorithms that test for recent infection have been developed [9,10]. Modest variation is not intrinsically problematic, but serious complications arise if, in some individuals, the immune response is such that they remain indefinitely classified as TRI-positive or if individuals revert back to a TRI-positive classification as a result of advanced disease or in the presence of antiretroviral therapy Both these complications arise for TRIs currently in use.
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