On the Use of Adjusted Cross-Sectional Estimators of HIV Incidence

• Activity Number: 83
• Type: Contributed
• Date/Time: Sunday, August 1, 2010 : 4:00 PM to 5:50 PM
• Sponsor: Section on Statistics in Epidemiology
• Author(s): Rui Wang*+ and Stephen Lagakos
• Companies: Harvard School of Public Health and Harvard School of Public Health
• Keywords: cross-sectional ; incidence ; less-sensitive test

Abstract

Cross-sectional methods for estimating HIV incidence, using a sensitive and a less sensitive diagnostic test, offer important advantages over longitudinal studies. Adjustments to the standard estimator have been proposed out of concerns for the false negative rate associated with the less sensitive test. However, there has been much debate on whether adjustment is needed. We evaluate the statistical properties of various estimators and derive the maximum likelihood estimator for the setting where a subset of infected subjects indefinitely remains non-reactive to the less-sensitive test. The standard unadjusted estimator should be used when all infected individuals would eventually become reactive to the less-sensitive test. When a subset of individuals would indefinitely remain non-reactive to the less-sensitive test, the maximum likelihood estimator for this setting should be used.