@article{fdi:010074065,
  title = {{P}opulation-level {HIV} incidence estimates using a combination of synthetic cohort and recency biomarker approaches in {K}wa{Z}ulu-{N}atal, {S}outh {A}frica},
  author = {{G}rebe, {E}. and {W}elte, {A}. and {J}ohnson, {L}. {F}. and van {C}utsem, {G}. and {P}uren, {A}. and {E}llman, {T}. and {E}tard, {J}ean-{F}ran{\c{c}}ois and {H}uerga, {H}. and {C}onsortium for the {E}valuation and {P}erformance of {HIV} {I}ncidence {A}ssays},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {T}here is a notable absence of consensus on how to generate estimates of population-level incidence. {I}ncidence is a considerably more sensitive indicator of epidemiological trends than prevalence, but is harder to estimate. {W}e used a novel hybrid method to estimate {HIV} incidence by age and sex in a rural district of {K}wa{Z}ulu-{N}atal, {S}outh {A}frica. {M}ethods {O}ur novel method uses an 'optimal weighting' of estimates based on an implementation of a particular 'synthetic cohort' approach (interpreting the age/time structure of prevalence, in conjunction with estimates of excess mortality) and biomarkers of 'recent infection' (combining {L}ag-{A}vidity, {B}io-{R}ad {A}vidity and viral load results to define recent infection, and adapting the method for age-specific incidence estimation). {D}ata were obtained from a population-based cross-sectional {HIV} survey conducted in {M}bongolwane and {E}showe health service areas in 2013. {R}esults {U}sing the combined method, we find that age-specific {HIV} incidence in females rose rapidly during adolescence, from 1.33 cases/100 person-years (95% {CI}: 0.98,1.67) at age 15 to a peak of 5.01/100{PY} (4.14,5.87) at age 23. {I}n males, incidence was lower, 0.34/100{PY} (0.00-0.74) at age 15, and rose later, peaking at 3.86/100{PY} (2.52-5.20) at age 30. {S}usceptible population-weighted average incidence in females aged 15-29 was estimated at 3.84/100{PY} (3.36-4.40), in males aged 15-29 at 1.28/100{PY} (0.68-1.50) and in all individuals aged 15-29 at 2.55/100{PY} (2.09-2.76). {U}sing the conventional recency biomarker approach, we estimated {HIV} incidence among females aged 15-29 at 2.99/100{PY} (1.79-4.36), among males aged 15-29 at 0.87/100{PY} (0.22-1.60) and among all individuals aged 15-59 at 1.66/100{PY} (1.13-2.27). {D}iscussion {HIV} incidence was very high in women aged 15-30, peaking in the early 20s. {M}en had lower incidence, which peaked at age 30. {T}he estimates obtained from the hybrid method are more informative than those produced by conventional analysis of biomarker data, and represents a more optimal use of available data than either the age-continuous biomarker or synthetic cohort methods alone. {T}he method is mainly useful at younger ages, where excess mortality is low and uncertainty in the synthetic cohort estimates is reasonably small. {C}onclusion {A}pplication of this method to large-scale population-based {HIV} prevalence surveys is likely to result in improved incidence surveillance over methods currently in wide use. {R}easonably accurate and precise age-specific estimates of incidence are important to target better prevention, diagnosis and care strategies.},
  keywords = {{AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {13},
  numero = {9},
  pages = {e0203638 [16 p.]},
  ISSN = {1932-6203},
  year = {2018},
  DOI = {10.1371/journal.pone.0203638},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074065},
}