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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
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Treatment-adjusted prevalence to assess HIV testing programmes.

Beth A Tippett Barr1, David Lowrance2, Cheryl Case Johnson2

  • 1US Centers for Disease Control and Prevention, Center for Global Health, PO Box 606, Village Market, 00621 Nairobi, Kenya.

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National HIV testing programs in sub-Saharan Africa face declining positivity rates. A new indicator, treatment-adjusted prevalence, helps estimate expected positivity by accounting for antiretroviral therapy coverage.

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Area of Science:

  • Public Health
  • Epidemiology
  • HIV/AIDS Research

Background:

  • Increasing scale-up of HIV testing and ART in sub-Saharan Africa.
  • Declining HIV positivity rates in national testing programs in high-prevalence areas.
  • Challenges in identifying individuals needing ART due to lower testing positivity.

Purpose of the Study:

  • Introduce and evaluate the 'treatment-adjusted prevalence' indicator.
  • Provide a practical benchmark for estimating expected adult HIV positivity in testing programs.
  • Address the limitations of current annual target-setting assumptions.

Main Methods:

  • Defining treatment-adjusted prevalence by adjusting national HIV prevalence for ART coverage.
  • Utilizing existing program data and population estimates for indicator calculation.
  • Illustrating application with country examples: Kenya, Malawi, South Sudan, and Zimbabwe.

Main Results:

  • Treatment-adjusted prevalence accounts for individuals on ART, offering a more realistic positivity benchmark.
  • The indicator was incorporated into WHO guidelines in 2019.
  • Demonstrates practical application and potential public health implications across different levels of health systems.

Conclusions:

  • Treatment-adjusted prevalence is a valuable tool for national HIV programs facing declining testing positivity.
  • It enables more accurate estimation of expected positivity, aiding resource allocation and program evaluation.
  • Supports strategic information and effective HIV response planning in sub-Saharan Africa.