Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda

Ouma, Joseph, Jeffery, Caroline ORCID: https://orcid.org/0000-0002-8023-0708, Valadez, Joseph ORCID: https://orcid.org/0000-0002-6575-6592, Wanyenze, Rhoda K., Todd, Jim and Levin, Jonathan (2020) 'Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda'. BMC Public Health, Vol 20, Issue 379.

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Abstract

Background: National or regional population-based HIV prevalence surveys have small sample sizes at district (or lower) administrative levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making. Health facility programme data, collected during service delivery is widely available, but since people self-select for HIV testing, HIV prevalence estimates based on it, is subject to selection bias. We present a statistical annealing technique, Hybrid Prevalence Estimation (HPE) that combines a small population-based survey sample with a facility-based sample to generate district level HIV prevalence estimates with associated confidence intervals.
Methods: We apply the HPE methodology to combine the 2011 Uganda AIDS indicator survey with the 2011 health facility HIV testing data to obtain HIV prevalence estimates for districts in Uganda. Multilevel logistic regression was used to obtain the propensity of testing for HIV in a health facility, and the propensity to test was used to combine the population survey and health facility HIV testing data to obtain the HPEs. We assessed comparability of the HPEs and survey-based estimates using Bland Altman analysis.
Results: The estimates ranged from 0.012 to 0.178 and had narrower confidence intervals compared to survey-based estimates. The average difference between HPEs and population survey estimates was 0.00 (95% CI: -0.04, 0.04). The HPE standard errors were 28.9% (95% CI: 23.4-34.4) reduced, compared to survey-based standard errors. Overall reduction in HPE standard errors compared survey-based standard errors ranged from 5.4% to 95%.
Conclusions: Facility data can be combined with population survey data to obtain more accurate HIV prevalence estimates for geographical areas with small population survey sample sizes. We recommend use of the methodology by district level managers to obtain more accurate HIV prevalence estimates to guide decision making without incurring additional data collection costs.

Item Type:	Article
Subjects:	WA Public Health > WA 100 General works WA Public Health > WA 105 Epidemiology WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.4 Epidemiology WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12889-020-8436-z
Depositing User:	Helen Fletcher
Date Deposited:	23 Apr 2020 10:49
Last Modified:	23 Apr 2020 10:49
URI:	https://archive.lstmed.ac.uk/id/eprint/14302

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