期刊
STATISTICS IN MEDICINE
卷 41, 期 8, 页码 1446-1461出版社
WILEY
DOI: 10.1002/sim.9296
关键词
biomarker; HIV; incidence; prevalence; recency assay
类别
资金
- U.S. National Institutes of Health [R56 AI143418]
- Scientific Computing Infrastructure at Fred Hutch - ORIP grant [S10OD028685]
Longitudinal cohorts for studying HIV infection incidence are difficult to implement, thus researchers have developed alternative strategies based on recency test methods. This article presents a theoretical framework, simulation study, and data analysis to evaluate the performance of two commonly used estimators for HIV incidence estimation. The findings provide recommendations for practical use of these estimators and discuss future methodological developments.
Longitudinal cohorts to determine the incidence of HIV infection are logistically challenging, so researchers have sought alternative strategies. Recency test methods use biomarker profiles of HIV-infected subjects in a cross-sectional sample to infer whether they are recently infected and to estimate incidence in the population. Two main estimators have been used in practice: one that assumes a recency test is perfectly specific, and another that allows for false-recent results. To date, these commonly used estimators have not been rigorously studied with respect to their assumptions and statistical properties. In this article, we present a theoretical framework with which to understand these estimators and interrogate their assumptions, and perform a simulation study and data analysis to assess the performance of these estimators under realistic HIV epidemiological dynamics. We find that the snapshot estimator and the adjusted estimator perform well when their corresponding assumptions hold. When assumptions on constant incidence and recency test characteristics fail to hold, the adjusted estimator is more robust than the snapshot estimator. We conclude with recommendations for the use of these estimators in practice and a discussion of future methodological developments to improve HIV incidence estimation via recency test.
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