Accurate HIV incidence estimates are essential for monitoring the HIV epidemic, determining public health priorities and assessing the impact of interventions. There are many approaches to estimating incidence. The “gold standard” approach is through observational studies, in which subjects are periodically monitored for HIV infection. However, such studies are time consuming, expensive and may provide Read More
The ability to estimate reliable HIV incidence rate ratios (IRRs) using cross-sectional data has vast public health importance in HIV surveillance and in prevention studies; it would reduce the need to recruit and maintain large and costly longitudinal cohorts. In fact, the most common method to evaluate HIV IRR is through cohort studies which are designed to estimate HIV incidence and the effects of interventions. However, the development of biomarkers which identify recently HIV infected individuals has made it possible to estimate HIV incidence using a cross-sectional survey. Following that, one study used classical statistical methods to analyse risk factors of recent HIV infection identified with a biomarker. It is therefore important to determine how that technology can be used to estimate incidence rate ratios.
Randomised controlled trials (RCTs) are used to evaluate HIV prevention methods conducted among populations with a heterogeneous risk of HIV infection among individuals. This heterogeneity is an underestimated problem which should be taken into account when designing and interpreting RCTs that test prevention methods of HIV heterosexual acquisition in adult sub-Saharan African populations with a high HIV incidence. When the effects of tested interventions are rapidly reversible, the use of the crossover design instead of a parallel design should be considered.