HIV incidence estimation using biomarkers for recent infection
Approximately one in six South African adults is infected with HIV, making it thecountry with the largest population of HIV positive individuals in the world. Strategiesfor monitoring this epidemic are an important area of research. In particular,estimation of incidence, the rate at which individuals are being infected, is a key indicatorof the scale of the epidemic. Since it is cheaper, quicker, easier and potentiallyless biased than prospective follow-up, incidence estimation from the cross-sectionalapplication of a biomarker that tests for recent infection has gained much attention.There is, however, controversy over how best to account for individuals thatpresent anomalous biomarker responses. The central contribution of the thesis isto derive a consistent incidence estimation approach that accounts for anomalousresponses. This approach is compared with other cross-sectional incidence estimatorsfound in the literature and shown to be less biased. Implications of the newapproach to survey design and the development of new biomarkers are explored.Application to survey data gathered by the Africa Center for Health and PopulationStudies showed consistent results when compared with incidence estimates derivedfrom follow-up. Aside from other theoretical contributions, the thesis also providesa systematic review of the application of the BED assay in incidence estimation withrecommendations on best current practice.
Year of publication: |
2011-06-10
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Authors: | McWalter, Thomas Andrew |
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