Comparing geographic area-based and classical population-based incidence and prevalence rates, and their confidence intervals

To quantify the HIV epidemic, the classical population-based prevalence and incidence rates (P rates) are the two most commonly used measures used for policy interventions. However, these P rates ignore the heterogeneity of the size of geographic region where the population resides. It is intuitive that with the same P rates, the likelihood for HIV can be much greater to spread in a population residing in a crowed small urban area than the same number of population residing in a large rural area. With this limitation, Chen and Wang (2017) proposed the geographic area-based rates (G rates) to complement the classical P rates. They analyzed the 2000–2012 US data on new HIV infections and persons living with HIV and found, as compared with other methods, using G rates enables researchers to more quickly detect increases in HIV rates. This capacity to reveal increasing rates in a more efficient and timely manner is a crucial methodological contribution to HIV research. To enhance this newly proposed concept of G rates, this article presents a discussion of 3 areas for further development of this important concept: (1) analysis of global HIV epidemic data using the newly proposed G rates to capture the changes globally; (2) development of the associated population density-based rates (D rates) to incorporate the heterogeneities from both geographical area and total population-at-risk; and (3) development of methods to calculate variances and confidence intervals for the P rates, G rates, and D rates to capture the variability of these indices.