TY - JOUR
T1 - Direct and indirect estimates of HIV-1 incidence in a high-prevalence population
AU - Cleghorn, Parley R.
AU - Jack, Noreen
AU - Murphy, Jacquelyn R.
AU - Edwards, Jeffrey
AU - Mahabir, Bisram
AU - Paul, Rosemary
AU - O'Brien, Thomas
AU - Greenberg, Michael
AU - Weinhold, Kent
AU - Bartholomew, Courtenay
AU - Brookmeyer, Ron
AU - Blattner, William A.
N1 - Funding Information:
This study was supported in part by NIH contracts NCI-CP-61022-21 and NCI-CP-40547 with the Caribbean Epidemiology Center, Port of Spain, Trinidad/Tobago.
PY - 1998/5/1
Y1 - 1998/5/1
N2 - While the worldwide AIDS epidemic continues to expand, directly measured incidence data are difficult to obtain. Methods to reliably estimate human immunodeficiency virus type 1 (HIV-1) incidence from more easily available data are particularly relevant in those parts of the world where prevalence is rising in heterosexually exposed populations. The authors set out to estimate HIV-1 incidence in a population of heterosexual sexually transmitted disease clinic attendees in Trinidad who had a known high prevalence of HIV- 1 subtype B. Over the period 1987-1995, HIV-1 incidence estimates from serial cross-sectional studies of HIV-1 prevalence, passive follow-up of clinic recidivists, modeling of early markers of HIV-1 infection (p24 antigen screening), and a cohort study of seronegative genital ulcer disease cases were compared. Measuring incidence density in the genital ulcer disease cases directly gave the highest estimate, 6.9% per annum. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per annum, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists gave estimates of 3.5% and 4.5% per annum, respectively. These results were found to be internally consistent. Indirect estimates of incidence based on prevalence data can give accurate surrogates of true incidence. Within limitations, even crude measures of incidence are robust enough for health planning and evaluation purposes. For planning vaccine efficacy trials, consistent conservative estimates may be used to evaluate populations before targeting them for cohort studies.
AB - While the worldwide AIDS epidemic continues to expand, directly measured incidence data are difficult to obtain. Methods to reliably estimate human immunodeficiency virus type 1 (HIV-1) incidence from more easily available data are particularly relevant in those parts of the world where prevalence is rising in heterosexually exposed populations. The authors set out to estimate HIV-1 incidence in a population of heterosexual sexually transmitted disease clinic attendees in Trinidad who had a known high prevalence of HIV- 1 subtype B. Over the period 1987-1995, HIV-1 incidence estimates from serial cross-sectional studies of HIV-1 prevalence, passive follow-up of clinic recidivists, modeling of early markers of HIV-1 infection (p24 antigen screening), and a cohort study of seronegative genital ulcer disease cases were compared. Measuring incidence density in the genital ulcer disease cases directly gave the highest estimate, 6.9% per annum. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per annum, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists gave estimates of 3.5% and 4.5% per annum, respectively. These results were found to be internally consistent. Indirect estimates of incidence based on prevalence data can give accurate surrogates of true incidence. Within limitations, even crude measures of incidence are robust enough for health planning and evaluation purposes. For planning vaccine efficacy trials, consistent conservative estimates may be used to evaluate populations before targeting them for cohort studies.
KW - Cohort studies
KW - Cross-sectional studies
KW - Genital diseases
KW - HIV- 1
KW - Incidence
KW - Male
KW - Prevalence
KW - Sexually transmitted diseases
KW - Vaccines
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U2 - 10.1093/oxfordjournals.aje.a009536
DO - 10.1093/oxfordjournals.aje.a009536
M3 - Article
C2 - 9583713
AN - SCOPUS:17344376051
SN - 0002-9262
VL - 147
SP - 834
EP - 839
JO - American journal of epidemiology
JF - American journal of epidemiology
IS - 9
ER -