Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 87, Issue -, Pages S6-S16Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000002710
Keywords
population-based surveys; HIV incidence; HIV viral load suppression; impact assessment; methods; Southern Africa
Categories
Funding
- President's Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Diseases Control and Prevention [1U2GGH000994, 5NU2GGH001226]
- The findings and conclusions in this article are those of the authors and do not necessarily represent the official position
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The population-based HIV impact assessment surveys conducted in Zimbabwe, Malawi, and Zambia successfully recruited nationally representative samples of households and achieved high response rates among eligible adults. The surveys collected comprehensive demographic, behavioral, and clinical data and conducted various HIV testing procedures with high data quality. Conducting these surveys with immediate return of test results was shown to be feasible, indicating the potential for continued use of this approach in assessing HIV impact on a national scale.
Background: The population-based HIV impact assessment (population-based HIV impact assessments) surveys are among the first to estimate national adult HIV incidence, subnational prevalence of viral load suppression, and pediatric HIV prevalence. We summarize the survey methods implemented in Zimbabwe, Malawi, and Zambia, as well as response rates and quality metrics. Methods: Each cross-sectional, household-based survey used a 2-stage cluster design. Survey preparations included sample design, questionnaire development, tablet programming for informed consent and data collection, community mobilization, establishing a network of satellite laboratories, and fieldworker training. Interviewers collected demographic, behavioral, and clinical information using tablets. Blood was collected for home-based HIV testing and counseling (HBTC) and point-of-care CD4(+) T-cell enumeration with results immediately returned. HIV-positive blood samples underwent laboratory-based confirmatory testing, HIV incidence testing, RNA polymerase chain reaction (viral load), DNA polymerase chain reaction (early infant diagnosis), and serum antiretroviral drug detection. Data were weighted for survey design, and chi square automatic interaction detection-based methods were used to adjust for nonresponse. Results: Each survey recruited a nationally representative, household-based sample of children and adults over a 6-10-month period in 2015 and 2016. Most (84%-90%) of the 12,000-14,000 eligible households in each country participated in the survey, with 77%-81% of eligible adults completing an interview and providing blood for HIV testing. Among eligible children, 59%-73% completed HIV testing. Across the 3 surveys, 97.8% of interview data were complete and had no errors. Conclusion: Conducting a national population-based HIV impact assessment with immediate return of HIV and other point-of-care test results was feasible, and data quality was high.
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