A comparison of South African national HIV incidence estimates: A critical appraisal of different methods

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dc.contributor.authorRehle, Thomasen_ZA
dc.contributor.authorJohnson, Leighen_ZA
dc.contributor.authorHallett, Timothyen_ZA
dc.contributor.authorMahy, Maryen_ZA
dc.contributor.authorKim, Andreaen_ZA
dc.contributor.authorOdido, Helenen_ZA
dc.contributor.authorOnoya, Dorinaen_ZA
dc.contributor.authorJooste, Seanen_ZA
dc.contributor.authorShisana, Oliveen_ZA
dc.contributor.authorPuren, Adrianen_ZA
dc.date.accessioned2015-11-16T04:08:05Z
dc.date.available2015-11-16T04:08:05Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: The interpretation of HIV prevalence trends is increasingly difficult as antiretroviral treatment programs expand. Reliable HIV incidence estimates are critical to monitoring transmission trends and guiding an effective national response to the epidemic. Methods and FINDINGS: We used a range of methods to estimate HIV incidence in South Africa: (i) an incidence testing algorithm applying the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) in combination with antiretroviral drug and HIV viral load testing; (ii) a modelling technique based on the synthetic cohort principle; and (iii) two dynamic mathematical models, the EPP/Spectrum model package and the Thembisa model. Overall, the different incidence estimation methods were in broad agreement on HIV incidence estimates among persons aged 15-49 years in 2012. The assay-based method produced slightly higher estimates of incidence, 1.72% (95% CI 1.38 - 2.06), compared with the mathematical models, 1.47% (95% CI 1.23 - 1.72) in Thembisa and 1.52% (95% CI 1.43 - 1.62) in EPP/Spectrum, and slightly lower estimates of incidence compared to the synthetic cohort, 1.9% (95% CI 0.8 - 3.1) over the period from 2008 to 2012. Among youth aged 15-24 years, a declining trend in HIV incidence was estimated by all three mathematical estimation methods. CONCLUSIONS: The multi-method comparison showed similar levels and trends in HIV incidence and validated the estimates provided by the assay-based incidence testing algorithm. Our results confirm that South Africa is the country with the largest number of new HIV infections in the world, with about 1 000 new infections occurring each day among adults aged 15-49 years in 2012.en_ZA
dc.identifier.apacitationRehle, T., Johnson, L., Hallett, T., Mahy, M., Kim, A., Odido, H., ... Puren, A. (2015). A comparison of South African national HIV incidence estimates: A critical appraisal of different methods. <i>PLoS One</i>, http://hdl.handle.net/11427/14988en_ZA
dc.identifier.chicagocitationRehle, Thomas, Leigh Johnson, Timothy Hallett, Mary Mahy, Andrea Kim, Helen Odido, Dorina Onoya, Sean Jooste, Olive Shisana, and Adrian Puren "A comparison of South African national HIV incidence estimates: A critical appraisal of different methods." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/14988en_ZA
dc.identifier.citationRehle, T., Johnson, L., Hallett, T., Mahy, M., Kim, A., Odido, H., ... & Stover, J. (2015). A comparison of South African national HIV incidence estimates: A critical appraisal of different methods. PloS one, 10(7), e0133255. doi:10.1371/journal.pone.0133255en_ZA
dc.identifier.ris TY - Journal Article AU - Rehle, Thomas AU - Johnson, Leigh AU - Hallett, Timothy AU - Mahy, Mary AU - Kim, Andrea AU - Odido, Helen AU - Onoya, Dorina AU - Jooste, Sean AU - Shisana, Olive AU - Puren, Adrian AB - BACKGROUND: The interpretation of HIV prevalence trends is increasingly difficult as antiretroviral treatment programs expand. Reliable HIV incidence estimates are critical to monitoring transmission trends and guiding an effective national response to the epidemic. Methods and FINDINGS: We used a range of methods to estimate HIV incidence in South Africa: (i) an incidence testing algorithm applying the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) in combination with antiretroviral drug and HIV viral load testing; (ii) a modelling technique based on the synthetic cohort principle; and (iii) two dynamic mathematical models, the EPP/Spectrum model package and the Thembisa model. Overall, the different incidence estimation methods were in broad agreement on HIV incidence estimates among persons aged 15-49 years in 2012. The assay-based method produced slightly higher estimates of incidence, 1.72% (95% CI 1.38 - 2.06), compared with the mathematical models, 1.47% (95% CI 1.23 - 1.72) in Thembisa and 1.52% (95% CI 1.43 - 1.62) in EPP/Spectrum, and slightly lower estimates of incidence compared to the synthetic cohort, 1.9% (95% CI 0.8 - 3.1) over the period from 2008 to 2012. Among youth aged 15-24 years, a declining trend in HIV incidence was estimated by all three mathematical estimation methods. CONCLUSIONS: The multi-method comparison showed similar levels and trends in HIV incidence and validated the estimates provided by the assay-based incidence testing algorithm. Our results confirm that South Africa is the country with the largest number of new HIV infections in the world, with about 1 000 new infections occurring each day among adults aged 15-49 years in 2012. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0133255 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - A comparison of South African national HIV incidence estimates: A critical appraisal of different methods TI - A comparison of South African national HIV incidence estimates: A critical appraisal of different methods UR - http://hdl.handle.net/11427/14988 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14988
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0133255
dc.identifier.vancouvercitationRehle T, Johnson L, Hallett T, Mahy M, Kim A, Odido H, et al. A comparison of South African national HIV incidence estimates: A critical appraisal of different methods. PLoS One. 2015; http://hdl.handle.net/11427/14988.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Rehle et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherMathematical modelsen_ZA
dc.titleA comparison of South African national HIV incidence estimates: A critical appraisal of different methodsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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