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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
HIV incidence in rural South Africa: Comparison of estimates from longitudinal surveillance and cross-sectional cBED assay testing
PLoS ONE, Volume 3, No. 11, Article e3640, Year 2008
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Description
Background: The BED IgG-Capture Enzyme Immunoassay (cBED assay), a test of recent HIV infection, has been used to estimate HIV incidence in cross-sectional HIV surveys. However, there has been concern that the assay overestimates HIV incidence to an unknown extent because it falsely classifies some individuals with non-recent HIV infections as recently infected. We used data from a longitudinal HIV surveillance in rural South Africa to measure the fraction of people with nonrecent HIV infection who are falsely classified as recently HIV-infected by the cBED assay (the long-term false-positive ratio (FPR)) and compared cBED assay-based HIV incidence estimates to longitudinally measured HIV incidence. Methodology/Principal Findings: We measured the long-term FPR in individuals with two positive HIV tests (in the HIV surveillance, 2003-2006) more than 306 days apart (sample size n = 1,065). We implemented four different formulae to calculate HIV incidence using cBED assay testing (n = 11,755) and obtained confidence intervals (CIs) by directly calculating the central 95th percentile of incidence values. We observed 4,869 individuals over 7,685 person-years for longitudinal HIV incidence estimation. The long-term FPR was 0.0169 (95% CI 0.0100-0.0266). Using this FPR, the cross-sectional cBED-based HIV incidence estimates (per 100 people per year) varied between 3.03 (95% CI 2.44-3.63) and 3.19 (95% CI 2.57-3.82), depending on the incidence formula. Using a long-term FPR of 0.0560 based on previous studies, HIV incidence estimates varied between 0.65 (95% CI 0.00-1.32) and 0.71 (95% CI 0.00-1.43). The longitudinally measured HIV incidence was 3.09 per 100 people per year (95% CI 2.69-3.52), after adjustment to the sex-age distribution of the sample used in cBED assay-based estimation. Conclusions/Significance: In a rural community in South Africa with high HIV prevalence, the long-term FPR of the cBED assay is substantially lower than previous estimates. The cBED assay performs well in HIV incidence estimation if the locally measured long-term FPR is used, but significantly underestimates incidence when a FPR estimate based on previous studies in other settings is used. © 2008 Bärnighausen et al.
Authors & Co-Authors
Bärnighausen, Till Winfried
South Africa, Durban
University of Kwazulu-natal
Wallrauch, Claudia G.
South Africa, Durban
University of Kwazulu-natal
Welte, Alex
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Stellenbosch
Stellenbosch University
McWalter, Thomas Andrew
South Africa, Johannesburg
University of the Witwatersrand
Mbizana, Nhlanhla
South Africa, Durban
University of Kwazulu-natal
Viljoen, Johannes I.
South Africa, Durban
University of Kwazulu-natal
Graham, Natalie J.
South Africa, Durban
University of Kwazulu-natal
Tanser, Frank C.
South Africa, Durban
University of Kwazulu-natal
Puren, Adrian
South Africa, Johannesburg
National Institute for Communicable Diseases
Newell, Marie Louise
South Africa, Durban
University of Kwazulu-natal
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Statistics
Citations: 85
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0003640
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa