Evaluating the BED capture enzyme immunoassay to estimate HIV incidence among adults in three countries in sub-Saharan Africa

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dc.contributor.authorKim, A. A.
dc.contributor.authorMcDougal, J. S.
dc.contributor.authorHargrove, J.
dc.contributor.authorRehle, T.
dc.contributor.authorPillay-Van Wyk, V.
dc.contributor.authorPuren, A.
dc.contributor.authorEkra, A.
dc.contributor.authorBorget-Alloue, M. Y.
dc.contributor.authorAdje-Toure, C.
dc.contributor.authorAbdullahi, A. S.
dc.contributor.authorOdawo, L.
dc.contributor.authorMarum, L.
dc.contributor.authorParekh, B. S.
dc.date.accessioned2011-05-15T16:03:20Z
dc.date.available2011-05-15T16:03:20Z
dc.date.issued2010
dc.description.abstractSerological assays for estimating HIV-1 incidence are prone to misclassification, limiting the accuracy of the incidence estimate. Adjustment factors have been developed and recommended for estimating assay-based HIV-1 incidence in cross-sectional settings. We evaluated the performance of the recommended adjustment factors for estimating incidence in national HIV surveys in three countries in sub-Saharan Africa. The BED-capture enzyme immunoassay was applied to stored blood specimens from (1) pregnant women aged 15-49 years attending antenatal clinics in Côte d'Ivoire (1998-2004), (2) adults aged 15-49 years participating in a demographic health survey in Kenya (2003), and (3) adults aged 15-49 years participating in a national household serosurvey in South Africa (2005). Assay-derived incidence estimates were corrected for misclassification using recommended adjustment factors and, where possible, were compared to mathematically modeled incidence in the same populations. Trends in HIV prevalence were compared to trends in assay-derived incidence to assess plausibility in the assay-derived trends. Unadjusted incidence was 3.8% [95% confidence interval (CI) 3.3-4.5] in Côte d'Ivoire, 3.5% (2.7-4.3) in Kenya, and 4.4% (CI 2.3-6.5]) in South Africa. Adjusted incidence was 2.9% (CI 2.1-3.7) in Côte d'Ivoire, 2.6% (CI 2.0-3.2) in Kenya, and 2.4% (CI 1.7-3.1) in South Africa. After adjustment, peak incidence shifted from older to younger age groups in Côte d'Ivoire and South Africa. Modeled HIV incidence was 1.0% (CI 1.02-1.08) in Kenya and 2.0% (CI 1.7-2.4) in South Africa. After applying the recommended adjustments factors, adjusted assay-derived estimates remained implausibly high in two of three populations evaluated. For more accurate measures of assay-derived population incidence, adjustment factors must be locally derived and validated. Until improved assays are available, caution should be applied in the use and interpretation of data from incidence assays. Copyright 2010, Mary Ann Liebert, Inc.
dc.description.versionArticle
dc.identifier.citationAIDS Research and Human Retroviruses
dc.identifier.citation26
dc.identifier.citation10
dc.identifier.issn8892229
dc.identifier.other10.1089/aid.2009.0218
dc.identifier.urihttp://hdl.handle.net/10019.1/12582
dc.subjectadjustment
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectblood
dc.subjectblood sampling
dc.subjectclinical trial
dc.subjectconfidence interval
dc.subjectcontrolled study
dc.subjectdemography
dc.subjectenzyme immunoassay
dc.subjectfemale
dc.subjectgroups by age
dc.subjecthealth survey
dc.subjecthousehold
dc.subjecthuman
dc.subjectHuman immunodeficiency virus 1
dc.subjectHuman immunodeficiency virus 1 infection
dc.subjectHuman immunodeficiency virus prevalence
dc.subjectKenya
dc.subjectmale
dc.subjectnonhuman
dc.subjectoutpatient department
dc.subjectpregnant woman
dc.subjectpriority journal
dc.subjectSouth Africa
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAIDS Serodiagnosis
dc.subjectCote d'Ivoire
dc.subjectCross-Sectional Studies
dc.subjectFemale
dc.subjectHIV Infections
dc.subjectHIV Seroprevalence
dc.subjectHumans
dc.subjectImmunoenzyme Techniques
dc.subjectKenya
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectModels, Theoretical
dc.subjectPopulation Surveillance
dc.subjectPregnancy
dc.subjectPregnancy Complications, Infectious
dc.subjectPrevalence
dc.subjectSouth Africa
dc.subjectYoung Adult
dc.titleEvaluating the BED capture enzyme immunoassay to estimate HIV incidence among adults in three countries in sub-Saharan Africa
dc.typeArticle
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