HIV incidence estimation using the BED capture enzyme immunoassay: systematic review and sensitivity analysis

Area of Science:

• Epidemiology
• Public Health
• Biostatistics

Background:

• HIV incidence estimation is vital for understanding epidemic trends and intervention effectiveness.
• Tests for recent HIV infection enable incidence estimation from cross-sectional surveys.
• The BED IgG-Capture Enzyme Immunoassay (BED assay) is a widely utilized commercial test for recent HIV infection.

Purpose of the Study:

• To systematically review studies using the BED assay for HIV incidence estimation.
• To investigate the sensitivity of incidence estimates to various methodological and parameter choices.
• To identify limitations and provide recommendations for improving future BED assay studies.

Main Methods:

• A systematic literature search identified 1181 unique studies, with 39 included in the final review.
• Reviews assessed study methodologies, including incidence formulae and parameter choices.
• Sensitivity analyses were performed to evaluate the impact of different estimation methods and parameters.

Main Results:

• BED assay surveys have been conducted globally across diverse populations.
• Most studies failed to account for assay imperfection or use locally valid calibration parameters.
• Incidence estimates demonstrated high sensitivity to methodological and parameter choices.
• Confidence intervals often omitted parameter uncertainty.

Conclusions:

• BED assay surveys can yield valid HIV incidence estimates when properly conducted.
• Insufficient accounting for assay imperfection is a common limitation in current studies.
• Future research should prioritize reporting complete data, using unbiased estimators with local parameters, and incorporating parameter uncertainty in confidence intervals.