Augmented Cross-Sectional Studies with Abbreviated Follow-up for Estimating HIV Incidence
Article first published online: 13 JUN 2011
© 2011, The International Biometric Society
Volume 68, Issue 1, pages 62–74, March 2012
How to Cite
Claggett, B., Lagakos, S. W. and Wang, R. (2012), Augmented Cross-Sectional Studies with Abbreviated Follow-up for Estimating HIV Incidence. Biometrics, 68: 62–74. doi: 10.1111/j.1541-0420.2011.01632.x
- Issue published online: 23 MAR 2012
- Article first published online: 13 JUN 2011
- Received May 2010. Revised April 2011. Accepted April 2011.
- Cross-sectional studies;
- False negative;
- Incidence estimators
Summary Cross-sectional HIV incidence estimation based on a sensitive and less-sensitive test offers great advantages over the traditional cohort study. However, its use has been limited due to concerns about the false negative rate of the less-sensitive test, reflecting the phenomenon that some subjects may remain negative permanently on the less-sensitive test. Wang and Lagakos (2010, Biometrics 66, 864–874) propose an augmented cross-sectional design that provides one way to estimate the size of the infected population who remain negative permanently and subsequently incorporate this information in the cross-sectional incidence estimator. In an augmented cross-sectional study, subjects who test negative on the less-sensitive test in the cross-sectional survey are followed forward for transition into the nonrecent state, at which time they would test positive on the less-sensitive test. However, considerable uncertainty exists regarding the appropriate length of follow-up and the size of the infected population who remain nonreactive permanently to the less-sensitive test. In this article, we assess the impact of varying follow-up time on the resulting incidence estimators from an augmented cross-sectional study, evaluate the robustness of cross-sectional estimators to assumptions about the existence and the size of the subpopulation who will remain negative permanently, and propose a new estimator based on abbreviated follow-up time (AF). Compared to the original estimator from an augmented cross-sectional study, the AF estimator allows shorter follow-up time and does not require estimation of the mean window period, defined as the average time between detectability of HIV infection with the sensitive and less-sensitive tests. It is shown to perform well in a wide range of settings. We discuss when the AF estimator would be expected to perform well and offer design considerations for an augmented cross-sectional study with abbreviated follow-up.