Adjusting HIV prevalence data from a program for the prevention of mother-to-child transmission for surveillance purposes in Uganda

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 46; no. 3; pp. 328 - 331
• Main Authors: FABIANI, Massimo, YOTI, Zabulon, NATTABI, Barbara, AYELLA, Emintone O, OPIO, Alex A, MUSINGUZI, Joshua, GARCIA CALLEJA, Jesus M, DECLICH, Silvia
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-2007
• Subjects: Adult; AIDS/HIV; Biological and medical sciences; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Human viral diseases; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Infectious diseases; Medical sciences; Microbiology; Miscellaneous; Observer Variation; Patient Acceptance of Health Care; Pregnancy; Pregnancy Complications, Infectious - prevention & control; Prevalence; Treatment Refusal; Uganda - epidemiology; Viral diseases; Virology; Uganda; Africa; Human; Prevalence; Microbiology; voluntary counseling and testing; Retroviridae; sentinel surveillance; prevention of mother-to-child transmission; Lentivirus; Epidemiology; HIV prevalence; Virology; Virus; Prevention; pregnant women; Female; Vertical transmission; Uganda; Human immunodeficiency virus
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0b013e31815724e7

To evaluate a method for adjusting estimates of HIV prevalence based on data from a program for the prevention of mother-to-child transmission (PMTCT) of HIV infection for the potential bias attributable to refusal of PMTCT-related testing.
Age-specific logistic regression models were used to estimate the HIV risk coefficients for 10 predictor variables among women who accepted the PMTCT-related testing (n = 1874) at an antenatal clinic in northern Uganda. These risk coefficients were used to predict the prevalence among women who were not tested (n = 1719) and to adjust the PMTCT-based prevalence for nonparticipation bias. Crude and adjusted PMTCT-based prevalence estimates were compared with the prevalence among women who were anonymously tested as part of routine sentinel surveillance (n = 2225).
The PMTCT-based prevalence represented an underestimate compared with that based on anonymous surveillance in 2004 (9.0% vs. 10.5%); in 2005, it constituted an overestimate (11.8% vs. 10.9%). Adjusting the PMTCT-based prevalence reduced the difference attributable to nonparticipation bias by approximately 70% in both years, so that the adjusted prevalence (10.1% in 2004 and 11.2% in 2005) was similar to the surveillance-based prevalence.
The adjustment method was effective in reducing the nonparticipation bias. Further studies are needed to assess the utility of PMTCT program data for HIV surveillance.