Supervie and Costagliola [1] comments suggest first that our conclusion is not in accordance with our analysis. Our estimated 0.09% undiagnosed HIV prevalence is below the 0.10% threshold suggested by health authorities for implementing universal screening. We agree that this difference is not statistically significant. However, that value, obtained in the most affected area in France, combined with the fact that undiagnosed infections were only found in high-risk groups,’ amply justifies our conclusion that a ‘universal testing strategy should be questioned in France’. A second remark states that, in a previous study [2], we claimed that the Emergency Department (ED) tested population was representative of the French population. That is a misinterpretation. We clearly mentioned that those two populations differed by over-representations of foreign-born people (particularly sub-Saharan Africans), women with more than 1 sexual partner during the last 12 months and more frequent HIV screening among the ED-tested population (see Table 1, p. 14) [2]. Thus, ED-undiagnosed HIV prevalence could not be considered the same as that of the general population. That situation then led us to estimate the general population prevalence with a calibration method [3]. Such a method is not applied to reduce bias in the sampling frame, as Supervie and Costagliola [1] claim, but to decrease the variance of estimators through the use of auxiliary information, which could not initially be taken into account in the design of the survey [4]. Our analysis used sociodemographic data, for example, sex and age from a population census, to perform a poststratification (also called standardization) and included data on sexual orientation and country of birth, which could not be crossed with all the other variables, and thus required a raking ratio method [5].Table 1: Characteristics of patients HIV tested in Emergency Departments and completing questionnaires compared with a reference general population.We thank Supervie and Costagliola [1] for giving us the opportunity to provide more details on the calibration method used, which, along with the management of missing data through multiple imputations allowed us to obtain an accurate and reliable estimate of the undiagnosed-HIV prevalence in the general population. Acknowledgements Conflicts of interest Dr A-C.C. reports receiving grants from Janssen–Cilag, Novartis, AstraZeneca, Aventis and Haeraus for consultancies, workshops and travel to meetings and accommodations. Dr P. de T. reports receiving grants from Abbott, BMS, Gilead, MSD, Tibotec Janssen and ViiV Healthcare for workshops and travel to meetings and accommodations. Dr F.S. reports receiving grants for the evaluation of Orasure RTD. The other authors have no disclosures to declare.
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