Using testing history to estimate HIV incidence in mothers living in resource-limited settings: Maximizing efficiency of a community health survey in Mozambique

PLOS Glob Public Health. 2023 May 31;3(5):e0001628. doi: 10.1371/journal.pgph.0001628. eCollection 2023.

Abstract

Obtaining rapid and accurate HIV incidence estimates is challenging because of the need for long-term follow-up for a large cohort. We estimated HIV incidence among women who recently delivered in southern Mozambique by leveraging data available in routine health cards. A cross-sectional household HIV-testing survey was conducted from October 2017 to April 2018 among mothers of children born in the previous four years in the Manhiça Health Demographic Surveillance System area. Randomly-selected mother-child pairs were invited to participate and asked to present documentation of their last HIV test result. HIV-testing was offered to mothers with no prior HIV-testing history, or with negative HIV results obtained over three months ago. HIV incidence was estimated as the number of mothers newly diagnosed with HIV per total person-years, among mothers with a prior documented HIV-negative test. Among 5000 mother-child pairs randomly selected, 3069 were interviewed, and 2221 reported a previous HIV-negative test. From this group, we included 1714 mothers who had taken a new HIV test during the survey. Most of mothers included (83.3%,1428/1714) had a previous documented HIV test result and date. Median time from last test to survey was 15.5 months (IQR:8.0-25.9). A total of 57 new HIV infections were detected over 2530.27 person-years of follow-up. The estimated HIV incidence was 2.25 (95% CI: 1.74-2.92) per 100 person-years. Estimating HIV incidence among women who recently delivered using a community HIV-focused survey coupled with previous HIV-testing history based on patients' clinical documents is an achievable strategy.

Grants and funding

This evaluation was supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control (CDC) under the terms of CoAg GH000479. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the funding agencies. AJCJ, JGC and MU received salary from PEPFAR through the U.S. CDC. ELV received funding from the European Respiratory Society and the European Union’s H2020 research and innovation program under Marie Sklodowska-Curie grant agreement no. 847462. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.