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HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage
OBJECTIVE: The use of routinely collected data from prevention of mother-to-child transmission programs (ANC-RT) has been proposed to monitor HIV epidemic trends. This poses several challenges for surveillance, one of them being that women may opt-out of testing and/or test stock-outs may result in...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919236/ https://www.ncbi.nlm.nih.gov/pubmed/31805029 http://dx.doi.org/10.1097/QAD.0000000000002356 |
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author | Maheu-Giroux, Mathieu Jahn, Andreas Kalua, Thokozani Mganga, Andrew Eaton, Jeffrey W. |
author_facet | Maheu-Giroux, Mathieu Jahn, Andreas Kalua, Thokozani Mganga, Andrew Eaton, Jeffrey W. |
author_sort | Maheu-Giroux, Mathieu |
collection | PubMed |
description | OBJECTIVE: The use of routinely collected data from prevention of mother-to-child transmission programs (ANC-RT) has been proposed to monitor HIV epidemic trends. This poses several challenges for surveillance, one of them being that women may opt-out of testing and/or test stock-outs may result in inconsistent service availability. In this study, we sought to empirically quantify the relationship between imperfect HIV testing coverage and HIV prevalence among pregnant women from ANC-RT data. DESIGN: We used reports from the ANC Register of all antenatal care (ANC) sites in Malawi (2011–2018), including 49 244 monthly observations, from 764 facilities, totaling 4 375 777 women. METHODS: Binomial logistic regression models with facility-level fixed effects and marginal standardization were used to assess the effect of testing coverage on HIV prevalence. RESULTS: Testing coverage increased from 78 to 98% over 2011–2018. We estimated that, had testing coverage been perfect, prevalence would have been 0.4% point lower (95% CI 0.3–0.5%) than the 7.9% observed prevalence, a relative overestimation of 6%. Bias in HIV prevalence was the highest in 2012, when testing coverage was lowest (72%), resulting in a relative overestimation of HIV prevalence of 15% (95% CI 12–17%). Overall, adjustments for imperfect testing coverage led to a subtler decline in HIV prevalence over 2011--2018. CONCLUSION: Malawi achieved high coverage of routine HIV testing in recent years. Nevertheless, imperfect testing coverage can lead to overestimation of HIV prevalence among pregnant women when coverage is suboptimal. ANC-RT data should be carefully evaluated for changes in testing coverage and completeness when used to monitor epidemic trends. |
format | Online Article Text |
id | pubmed-6919236 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-69192362020-03-10 HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage Maheu-Giroux, Mathieu Jahn, Andreas Kalua, Thokozani Mganga, Andrew Eaton, Jeffrey W. AIDS Editorial OBJECTIVE: The use of routinely collected data from prevention of mother-to-child transmission programs (ANC-RT) has been proposed to monitor HIV epidemic trends. This poses several challenges for surveillance, one of them being that women may opt-out of testing and/or test stock-outs may result in inconsistent service availability. In this study, we sought to empirically quantify the relationship between imperfect HIV testing coverage and HIV prevalence among pregnant women from ANC-RT data. DESIGN: We used reports from the ANC Register of all antenatal care (ANC) sites in Malawi (2011–2018), including 49 244 monthly observations, from 764 facilities, totaling 4 375 777 women. METHODS: Binomial logistic regression models with facility-level fixed effects and marginal standardization were used to assess the effect of testing coverage on HIV prevalence. RESULTS: Testing coverage increased from 78 to 98% over 2011–2018. We estimated that, had testing coverage been perfect, prevalence would have been 0.4% point lower (95% CI 0.3–0.5%) than the 7.9% observed prevalence, a relative overestimation of 6%. Bias in HIV prevalence was the highest in 2012, when testing coverage was lowest (72%), resulting in a relative overestimation of HIV prevalence of 15% (95% CI 12–17%). Overall, adjustments for imperfect testing coverage led to a subtler decline in HIV prevalence over 2011--2018. CONCLUSION: Malawi achieved high coverage of routine HIV testing in recent years. Nevertheless, imperfect testing coverage can lead to overestimation of HIV prevalence among pregnant women when coverage is suboptimal. ANC-RT data should be carefully evaluated for changes in testing coverage and completeness when used to monitor epidemic trends. Lippincott Williams & Wilkins 2019-12-15 2019-09-06 /pmc/articles/PMC6919236/ /pubmed/31805029 http://dx.doi.org/10.1097/QAD.0000000000002356 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Editorial Maheu-Giroux, Mathieu Jahn, Andreas Kalua, Thokozani Mganga, Andrew Eaton, Jeffrey W. HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title | HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title_full | HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title_fullStr | HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title_full_unstemmed | HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title_short | HIV surveillance based on routine testing data from antenatal clinics in Malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
title_sort | hiv surveillance based on routine testing data from antenatal clinics in malawi (2011–2018): measuring and adjusting for bias from imperfect testing coverage |
topic | Editorial |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919236/ https://www.ncbi.nlm.nih.gov/pubmed/31805029 http://dx.doi.org/10.1097/QAD.0000000000002356 |
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