Repository logo
 

Cross-Sectional HIV Incidence Surveillance: A Benchmarking of Approaches for Estimating the 'Mean Duration of Recent Infection'.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Kassanjee, Reshma 
De Angelis, Daniela  ORCID logo  https://orcid.org/0000-0001-6619-6112
Farah, Marian 
Hanson, Debra 
Labuschagne, Jan Phillipus Lourens 

Abstract

The application of biomarkers for 'recent' infection in cross-sectional HIV incidence surveillance requires the estimation of critical biomarker characteristics. Various approaches have been employed for using longitudinal data to estimate the Mean Duration of Recent Infection (MDRI) - the average time in the 'recent' state. In this systematic benchmarking of MDRI estimation approaches, a simulation platform was used to measure accuracy and precision of over twenty approaches, in thirty scenarios capturing various study designs, subject behaviors and test dynamics that may be encountered in practice. Results highlight that assuming a single continuous sojourn in the 'recent' state can produce substantial bias. Simple interpolation provides useful MDRI estimates provided subjects are tested at regular intervals. Regression performs the best - while 'random effects' describe the subject-clustering in the data, regression models without random effects proved easy to implement, stable, and of similar accuracy in scenarios considered; robustness to parametric assumptions was improved by regressing 'recent'/'non-recent' classifications rather than continuous biomarker readings. All approaches were vulnerable to incorrect assumptions about subjects' (unobserved) infection times. Results provided show the relationships between MDRI estimation performance and the number of subjects, inter-visit intervals, missed visits, loss to follow-up, and aspects of biomarker signal and noise.

Description

Keywords

HIV, biomarkers for recent infection, cross-sectional incidence surveys, duration of recent infection, incidence estimation

Journal Title

Stat Commun Infect Dis

Conference Name

Journal ISSN

2194-6310
1948-4690

Volume Title

9

Publisher

Walter de Gruyter GmbH
Sponsorship
MRC Funding: MC_UP_1302/3’ and U105260566