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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.


Racial/Ethnic disparities in the undiagnosed fraction with HIV.The plot shows the group-specific estimates under different assumptions: constant or time-varying incidence, and base case or upper bound estimate of the TID from Fig 1. The time-varying incidence estimates are summarized by the lowest and highest observed values from 2006–2012.
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pone.0129551.g003: Racial/Ethnic disparities in the undiagnosed fraction with HIV.The plot shows the group-specific estimates under different assumptions: constant or time-varying incidence, and base case or upper bound estimate of the TID from Fig 1. The time-varying incidence estimates are summarized by the lowest and highest observed values from 2006–2012.

Mentions: The testing history data show significant variation by race/ethnicity in the estimated time from infection to diagnosis. The mean possible infection interval estimates were 2.8, 4.3 and 3.4 years, for Whites, African Americans and Hispanics respectively (F = 4.5 (2,199), p < 0.05). The medians are 1.2, 1.8 and 1.5 respectively. As shown in Fig 3, this contributes to relatively large differences in estimates of the undiagnosed fraction between White MSM, and MSM of color.


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)

Racial/Ethnic disparities in the undiagnosed fraction with HIV.The plot shows the group-specific estimates under different assumptions: constant or time-varying incidence, and base case or upper bound estimate of the TID from Fig 1. The time-varying incidence estimates are summarized by the lowest and highest observed values from 2006–2012.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0129551.g003: Racial/Ethnic disparities in the undiagnosed fraction with HIV.The plot shows the group-specific estimates under different assumptions: constant or time-varying incidence, and base case or upper bound estimate of the TID from Fig 1. The time-varying incidence estimates are summarized by the lowest and highest observed values from 2006–2012.
Mentions: The testing history data show significant variation by race/ethnicity in the estimated time from infection to diagnosis. The mean possible infection interval estimates were 2.8, 4.3 and 3.4 years, for Whites, African Americans and Hispanics respectively (F = 4.5 (2,199), p < 0.05). The medians are 1.2, 1.8 and 1.5 respectively. As shown in Fig 3, this contributes to relatively large differences in estimates of the undiagnosed fraction between White MSM, and MSM of color.

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.