A Method for Estimating the Proportion of HIV-Infected Persons That Have Been Diagnosed and Application to China
- PDF / 443,030 Bytes
- 12 Pages / 439.37 x 666.142 pts Page_size
- 71 Downloads / 163 Views
A Method for Estimating the Proportion of HIV-Infected Persons That Have Been Diagnosed and Application to China Ron Brookmeyer1
· Zunyou Wu2
Received: 13 October 2018 / Revised: 7 April 2019 / Accepted: 22 April 2019 © International Chinese Statistical Association 2019
Abstract Estimation of the proportion of living HIV-infected persons that have been diagnosed is critical for tracking progress toward meeting the UNAIDS goal that all persons who need HIV treatment receive it. The objective of this article is to develop a method for estimating that proportion. The methodological problem is that persons with undiagnosed HIV infection are not directly observable and are a “hidden” population. Here, we propose a methodology for estimating the proportion diagnosed that is relatively simple to implement. The key idea is that in many settings certain health conditions such as pregnancy or an upcoming surgery lead to mandatory HIV tests. The size of the undiagnosed infected population can be estimated from the numbers of infected persons diagnosed by mandatory tests and an estimate of the rate that persons in the undiagnosed infected population receive mandatory tests. We discuss approaches for estimating the rate of mandatory testing in the undiagnosed population, such as surgical or pregnancy rates. We develop estimators of the proportion diagnosed and confidence interval procedures. Sample size considerations and sensitivity analyses to underlying assumptions are considered. The proposed methods can be performed at a local level and within demographic strata. Implementation of the method is simple and requires neither historical HIV/AIDS surveillance data nor biomarkers such as CD4 cell counts. The methods are applied to data from Dehong Prefecture in Yunnan Province, China. Keywords AIDS · Hidden population · HIV · Prevalence · Undiagnosed
B
Ron Brookmeyer [email protected] Zunyou Wu [email protected]
1
Department of Biostatistics, University of California, Los Angeles, CA 90095, USA
2
Division of HIV Prevention, NCAIDS/China CDC, Beijing, China
123
Statistics in Biosciences
1 Introduction A goal of the Joint United Nations Program on HIV/AIDS (UNAIDS) to control the AIDS epidemic is for all persons who need HIV treatment receive treatment. UNAIDS proposed three targets by the year 2020 which are known as the 90-90-90 targets to work toward reaching the goal [18]. The first target is for 90% of all people living with HIV to be diagnosed with HIV. The second target is for 90% of all persons with diagnosed HIV infection to receive anti-retroviral therapy. The third target is for 90% of all people receiving anti-retroviral therapy to achieve viral suppression. Persons on anti-retrovirals will become virally suppressed making them less infectious to others. Accurate methods are required to evaluate progress toward achieving these targets. A systematic review of methods for measuring progress toward the 90-90-90 targets concluded that a wide range of methods are being used and not all of the methods are
Data Loading...
