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A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

Fellows IE, Morris M, Birnbaum JK, Dombrowski JC, Buskin S, Bennett A, Golden MR - PLoS ONE (2015)

Bottom Line: Two methods are presented and compared.A sensitivity analysis on the key distributional assumption gives an upper bound of 11%.The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.

View Article: PubMed Central - PubMed

Affiliation: Fellows Statistics, San Diego, CA, United States of America.

ABSTRACT
We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calculation that can be used to assess changes in the undiagnosed fraction over time. The second makes an assumption of constant incidence, allowing the estimate to be expressed as a simple closed formula calculation. We demonstrate the methods with an application to HIV diagnoses among men who have sex with men (MSM) from Seattle/King County. The estimates suggest that 6% of HIV-infected MSM in King County are undiagnosed, about one-third of the comparable national estimate. A sensitivity analysis on the key distributional assumption gives an upper bound of 11%. The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.

No MeSH data available.


Observed and estimated quarterly HIV incidence among MSM in King County by quarter.(A) HIV incidence estimates and the observed number of diagnosed cases. The estimation uses a quadratic smoothing parameter of 0.1. (B) Estimates of the total number of undiagnosed HIV+ cases by quarter.
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pone.0129551.g002: Observed and estimated quarterly HIV incidence among MSM in King County by quarter.(A) HIV incidence estimates and the observed number of diagnosed cases. The estimation uses a quadratic smoothing parameter of 0.1. (B) Estimates of the total number of undiagnosed HIV+ cases by quarter.

Mentions: The back-calculation estimates of HIV incidence yielded almost identical quarterly counts for both the base case and upper bound TID models: 49.7–57.5 and 49.6–56.8 respectively. Fig 2A shows the estimated incidence counts over time for each model, along with the observed quarterly diagnosis counts. Both models find a relatively stable incidence over the 2006 to 2012 period, suggesting that the simpler constant incidence model can be used to estimate the undiagnosed fraction for these data.


A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

Fellows IE, Morris M, Birnbaum JK, Dombrowski JC, Buskin S, Bennett A, Golden MR - PLoS ONE (2015)

Observed and estimated quarterly HIV incidence among MSM in King County by quarter.(A) HIV incidence estimates and the observed number of diagnosed cases. The estimation uses a quadratic smoothing parameter of 0.1. (B) Estimates of the total number of undiagnosed HIV+ cases by quarter.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4510124&req=5

pone.0129551.g002: Observed and estimated quarterly HIV incidence among MSM in King County by quarter.(A) HIV incidence estimates and the observed number of diagnosed cases. The estimation uses a quadratic smoothing parameter of 0.1. (B) Estimates of the total number of undiagnosed HIV+ cases by quarter.
Mentions: The back-calculation estimates of HIV incidence yielded almost identical quarterly counts for both the base case and upper bound TID models: 49.7–57.5 and 49.6–56.8 respectively. Fig 2A shows the estimated incidence counts over time for each model, along with the observed quarterly diagnosis counts. Both models find a relatively stable incidence over the 2006 to 2012 period, suggesting that the simpler constant incidence model can be used to estimate the undiagnosed fraction for these data.

Bottom Line: Two methods are presented and compared.A sensitivity analysis on the key distributional assumption gives an upper bound of 11%.The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.

View Article: PubMed Central - PubMed

Affiliation: Fellows Statistics, San Diego, CA, United States of America.

ABSTRACT
We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calculation that can be used to assess changes in the undiagnosed fraction over time. The second makes an assumption of constant incidence, allowing the estimate to be expressed as a simple closed formula calculation. We demonstrate the methods with an application to HIV diagnoses among men who have sex with men (MSM) from Seattle/King County. The estimates suggest that 6% of HIV-infected MSM in King County are undiagnosed, about one-third of the comparable national estimate. A sensitivity analysis on the key distributional assumption gives an upper bound of 11%. The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.

No MeSH data available.