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Comparative Study
. 2011 Mar 7;6(3):e17535.
doi: 10.1371/journal.pone.0017535.

Estimating HIV incidence among adults in Kenya and Uganda: a systematic comparison of multiple methods

Andrea A Kim  1 , Timothy Hallett, John Stover, Eleanor Gouws, Joshua Musinguzi, Patrick K Mureithi, Rebecca Bunnell, John Hargrove, Jonathan Mermin, Reinhard K Kaiser, Anne Barsigo, Peter D Ghys
Affiliations
Comparative Study

Estimating HIV incidence among adults in Kenya and Uganda: a systematic comparison of multiple methods

Andrea A Kim et al. PLoS One. .

Abstract

Background: Several approaches have been used for measuring HIV incidence in large areas, yet each presents specific challenges in incidence estimation.

Methodology/principal findings: We present a comparison of incidence estimates for Kenya and Uganda using multiple methods: 1) Epidemic Projections Package (EPP) and Spectrum models fitted to HIV prevalence from antenatal clinics (ANC) and national population-based surveys (NPS) in Kenya (2003, 2007) and Uganda (2004/2005); 2) a survey-derived model to infer age-specific incidence between two sequential NPS; 3) an assay-derived measurement in NPS using the BED IgG capture enzyme immunoassay, adjusted for misclassification using a locally derived false-recent rate (FRR) for the assay; (4) community cohorts in Uganda; (5) prevalence trends in young ANC attendees. EPP/Spectrum-derived and survey-derived modeled estimates were similar: 0.67 [uncertainty range: 0.60, 0.74] and 0.6 [confidence interval: (CI) 0.4, 0.9], respectively, for Uganda (2005) and 0.72 [uncertainty range: 0.70, 0.74] and 0.7 [CI 0.3, 1.1], respectively, for Kenya (2007). Using a local FRR, assay-derived incidence estimates were 0.3 [CI 0.0, 0.9] for Uganda (2004/2005) and 0.6 [CI 0, 1.3] for Kenya (2007). Incidence trends were similar for all methods for both Uganda and Kenya.

Conclusions/significance: Triangulation of methods is recommended to determine best-supported estimates of incidence to guide programs. Assay-derived incidence estimates are sensitive to the level of the assay's FRR, and uncertainty around high FRRs can significantly impact the validity of the estimate. Systematic evaluations of new and existing incidence assays are needed to the study the level, distribution, and determinants of the FRR to guide whether incidence assays can produce reliable estimates of national HIV incidence.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Trends in HIV incidence by estimation method, adults aged 15–49 years, Kenya, 2000–2007.
Figure 2
Figure 2. Trends in HIV prevalence among young women aged 15–24 years attending antenatal clinics in Kenya, 2000–2005.
Figure 3
Figure 3. Trends in HIV incidence by estimation method, adults aged 15–49 years, Uganda, 2000–2007.
Figure 4
Figure 4. Trends in HIV prevalence among young women aged 15–24 years attending antenatal clinics in Uganda, 2000–2007.
See this image and copyright information in PMC

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