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.
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Acknowledgements
Authors would like to thank Song Duan of the Dehong Prefecture Center for Disease Control and Prevention, Mangshi, China, for providing the surgery and pregnancy data from Dehong Prefecture. This work was also supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) NIMH Grant MH58107 and NIH Grant R01-AI095068. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
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Brookmeyer, R., Wu, Z. A Method for Estimating the Proportion of HIV-Infected Persons That Have Been Diagnosed and Application to China. Stat Biosci 12, 267–278 (2020). https://doi.org/10.1007/s12561-019-09240-8
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DOI: https://doi.org/10.1007/s12561-019-09240-8