HIV incidence in rural South Africa : comparison of estimates from longitudinal surveillance and cross-sectional cBED assay testing

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dc.contributor.authorBarnighausen, Till
dc.contributor.authorWallrauch, Claudia
dc.contributor.authorWelte, Alex
dc.contributor.authorMcWalter, Thomas A.
dc.contributor.authorMbizana, Nhlanhla
dc.contributor.authorViljoen, Johannes
dc.contributor.authorGraham, Natalie
dc.contributor.authorTanser, Frank
dc.contributor.authorPuren, Adrian
dc.contributor.authorNewell, Marie-Louise
dc.date.accessioned2011-05-15T16:00:16Z
dc.date.available2011-05-15T16:00:16Z
dc.date.issued2008-04
dc.descriptionThe original publication is available at http:/www.plosone.orgen_ZA
dc.description.abstractBackground: 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.en_ZA
dc.description.versionPublishers' Version
dc.format.extent8 p.
dc.identifier.citationBarnighausen, T. et al. 2008. HIV incidence in rural South Africa: comparison of estimates from longitudinal surveillance and cross-sectional cBED Assay Testing. PLoS ONE, 3(11): e3640, doi:10.1371/journal.pone.0003640.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0003640
dc.identifier.urihttp://hdl.handle.net/10019.1/11612
dc.publisherPublic Library of Science (PLOS)
dc.rights.holderAuthors retain copyright
dc.subjectHIV infections -- Diagnosis -- South Africaen_ZA
dc.subjectHIV infections -- South Africa -- Longitudinal studiesen_ZA
dc.subjectcBED Assay Testingen_ZA
dc.titleHIV incidence in rural South Africa : comparison of estimates from longitudinal surveillance and cross-sectional cBED assay testingen_ZA
dc.typeArticleen_ZA
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