Restricted accessResearch articleFirst published online 2021-5
Comparison of cohort characteristics in Central Africa International Epidemiology Databases to Evaluate AIDS and Demographic Health Surveys: Rwanda and Burundi
Clinical health record data are used for HIV surveillance, but the extent to which these data are population representative is not clear. We compared age, marital status, body mass index, and pregnancy distributions in the Central Africa International Databases to Evaluate AIDS (CA-IeDEA) cohorts in Burundi and Rwanda to all people living with HIV and the subpopulation reporting receiving a previous HIV test result in the Demographic and Health Survey (DHS) data, restricted to urban areas, where CA-IeDEA sites are located. DHS uses a probabilistic sample for population-level HIV prevalence estimates. In Rwanda, the CA-IeDEA cohort and DHS populations were similar with respect to age and marital status for men and women, which was also true in Burundi among women. In Burundi, the CA-IeDEA cohort had a greater proportion of younger and single men than the DHS data, which may be a result of outreach to sexual minority populations at CA-IeDEA sites and economic migration patterns. In both countries, the CA-IeDEA cohorts had a higher proportion of underweight individuals, suggesting that symptomatic individuals are more likely to access care in these settings. Multiple sources of data are needed for HIV surveillance to interpret potential biases in epidemiological data.
WilsonDHalperinDT. “Know your epidemic, know your response”: a useful approach, if we get it right. The Lancet2008; 372: 423–426. DOI: 10.1016/S0140-6736(08)60883-1
2.
RiceBSanchezTBaralS, et al.Know your epidemic, strengthen your response: developing a new HIV surveillance architecture to guide HIV resource allocation and target decisions. JMIR Public Health Surveill2018; 4: e18. DOI: 10.2196/publichealth.9386
3.
WHO. Consolidated guidelines on person-centred HIV patient monitoring and case surveillance. Geneva, Switzerland: World Health Organization; 2017.
4.
HarklerodeRSchwarczSHargreavesJ, et al.Feasibility of establishing HIV case-based surveillance to measure progress along the health sector cascade: situational assessments in Tanzania, South Africa, and Kenya. JMIR Public Health Surveill2017; 3: e44. DOI: 10.2196/publichealth.7610
5.
HochgesangMZamudio-HaasSMoranL, et al.Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique. Int J Med Inform2017; 97: 322–330. DOI: 10.1016/j.ijmedinf.2016.11.002
6.
EggerMEkoueviDKWilliamsC, et al.Cohort profile: the international epidemiological databases to evaluate AIDS (IeDEA) in sub-Saharan Africa. Int J Epidemiol2012; 41: 1256–1264. DOI: 10.1093/ije/dyr080
7.
ChammartinFDao OstinelliCHAnastosK, et al.International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019. BMJ Open2020; 10: e035246. DOI: 10.1136/bmjopen-2019-035246
8.
TatemKSRomoMLMcVeighKH, et al.Comparing prevalence estimates from population-based surveys to inform surveillance using electronic health records. Preventing Chronic Dis2017; 14: E44. DOI: 10.5888/pcd14.160516
9.
Von ElmEAltmanDGEggerM, et al.The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies*. Bull World Health Organ2007; 85: 867–872. DOI: 10.2471/BLT.07.045120
10.
FennerLBallifMGraberC, et al.Tuberculosis in antiretroviral treatment programs in lower income countries: Availability and use of diagnostics and screening. PLoS ONE2013; 8: e77697. DOI: 10.1371/journal.pone.0077697
11.
HoferCBKeiserOZwahlenM, et al.In utero exposure to antiretroviral drugs. Pediatr Infect Dis J2015; 35: 1–77. DOI: 10.1097/INF.0000000000000926
12.
RothmanKJGallacherJEHatchEE. Why representativeness should be avoided. Int J Epidemiol2013; 42: 1012–1014. DOI: 10.1093/ije/dys223
13.
HolmesJRDinhTHFarachN, et al.Status of HIV case-based surveillance implementation — 39 U.S. PEPFAR-supported countries. MMWR Morb Mortal Wkly Rep2019; 68: 1089–1095: DOI: 10.15585/mmwr.mm6847a2external
14.
CorsiDJNeumanMFinlayJE, et al.Demographic and health surveys: a profile. Int J Epidemiol2012; 41: 1602–1613. DOI: 10.1093/ije/dys184
15.
Institut de Statistiques et d’Études Économiques du Burundi (ISTEEBU), Ministère de la Santé Publique et de la Lutte contre le Sida (MSPLS)/Burundi and International I. Enquête démographique et de santé Burundi 2010. 2012. Bujumbura, Burundi: ISTEEBU, MSPLS, and ICF International.
16.
MishraVVaessenMBoermaJT, et al.HIV testing in national population-based surveys: experience from the demographic and health surveys. Bull World Health Organ2006; 84: 537–545.
ICF. Demographic and Health Surveys (Various) [Datasets]. Rockville, Maryland, USA: ICF [Distributor], 2005–2017.
19.
Ministère à la Présidence chargé de la Bonne Gouvernance et du Plan (MPBGP), Ministère de la Santé Publique et de la Lutte contre le Sida (MSPLS), Institut de Statistiques et d'Études Économiques du Burundi (ISTEEBU), et al. Troisième enquête démographique et de santé au Burundi. Bujumbura, Burundi: ISTEEBU, MSPLS, and ICF, 2017.
20.
Institut National de la Statistique du Rwanda (INSR) and MacroO. Rwanda demographic and health survey 2005. Calverton, MD: INSR and ORC Macro; 2006.
21.
National Institute of Statistics of Rwanda (NISR) MoHMR, ICF International. Rwanda demographic and health survey 2010. Calverton, Maryland, USA: NISR/Rwanda, MOH/Rwanda, and ICF International; 2012.
22.
National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning/Rwanda and Ministry of Health/Rwanda II. Rwanda demographic and health survey 2014-15. Kigali, Rwanda: National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning/Rwanda, Ministry of Health/Rwanda, and ICF International; 2015.
23.
Bureau Central de Recensement. Recensement général de la population et de l’habitat du Burundi 2008. Bujumbura, Burundi: Bureau Central du Recensement, Ministère de l’Interieur; 2008.
24.
National Institute of Statistics of Rwanda (NISR) MoFaEPM. Rwanda third general census of population and housing - 2002. Kigali, Rwanda: NISR, MINECOFIN; 2003.
25.
National Institute of Statistics of Rwanda (NISR) MoFaEPM. Rwanda fourth population and housing census - 2012. Kigali, Rwanda: NISR, MINECOFIN; 2012.
26.
BulageLSsewanyanaINankabirwaV, et al.Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda, August 2014-July 2015. BMC Infect Dis2017; 17: 326. DOI: 10.1186/s12879-017-2428-3
27.
LessellsRJMutevedziPCCookeGS, et al.Retention in HIV care for individuals not yet eligible for antiretroviral therapy: Rural KwaZulu-Natal, South Africa. JAIDS J Acquired Immune Deficiency Syndromes2011; 56: e79–e86. DOI: 10.1097/QAI.0b013e3182075ae2
28.
MaskewMBrennanATMacPhailAP, et al.Poorer ART outcomes with increasing age at a large public sector HIV clinic in Johannesburg, South Africa. J Int Assoc Physicians AIDS Care2011; 11: 57–65. DOI: 10.1177/1545109711421641
29.
NashDWuYElulB, et al.Program-level and contextual-level determinants of low-median CD4+ cell count in cohorts of persons initiating ART in eight sub-Saharan African countries. AIDS2011; 25: 1523–1533. DOI: 10.1097/QAD.0b013e32834811b2
30.
LankowskiAJSiednerMJBangsbergDR, et al.Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review. AIDS Behav2014; 18: 1199–1223. DOI: 10.1007/s10461-014-0729-8
31.
TuckerJDTsoLSHallB, et al.Enhancing public health HIV interventions: A qualitative meta-synthesis and systematic review of studies to improve linkage to care, adherence, and retention. EBioMedicine2017; 17: 163–171. DOI: 10.1016/j.ebiom.2017.01.036
32.
PulerwitzJGottertAKahnK, et al.Gender norms and HIV testing/treatment uptake: evidence from a large population-based sample in South Africa. AIDS Behav2019; 23: 162. DOI: 10.1007/s10461-019-02603-8
33.
HeestermansTBrowneJLAitkenSC, et al.Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health2016; 1: e000125. DOI: 10.1136/bmjgh-2016-000125
34.
BorJRosenSChimbindiN, et al.Mass HIV treatment and sex disparities in life expectancy: demographic surveillance in rural South Africa. PLOS Med2015; 12: e1001905. DOI: 10.1371/journal.pmed.1001905
35.
WoelkGBNdatimanaDBehanS, et al.Retention of mothers and infants in the prevention of mother-to-child transmission of HIV programme is associated with individual and facility-level factors in Rwanda. J Int AIDS Soc2016; 19: 20837. DOI: 10.7448/ias.19.5.20837
36.
RedaAABiadgilignS. Determinants of adherence to antiretroviral therapy among HIV-infected patients in Africa. AIDS Res Treat2012; 2012: 1–8. DOI: 10.1155/2012/574656
37.
MartinezSSCampaABussmannH, et al.Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana. Br J Nutr2016; 115: 2114–2121. DOI: 10.1017/S0007114516001409
38.
Van der SandeMABVan der LoeffMFSAveikaAA, et al.Body mass index at time of HIV diagnosis. JAIDS J Acquired Immune Deficiency Syndromes2004; 37: 1288–1294. DOI: 10.1097/01.qai.0000122708.59121.03
39.
WelchCPetersenIWaltersK, et al.Two-stage method to remove population- and individual-level outliers from longitudinal data in a primary care database. Pharmacoepidemiol Drug Saf2012; 21: 725–732. DOI: 10.1002/pds.2270
HojatMXuG. A visitor’s guide to effect sizes - statistical significance versus practical (clinical) importance of research findings. Adv Health Sci Education2004; 9: 241–249. DOI: 10.1023/B:AHSE.0000038173.00909.f6
43.
KitturNDSecuraGMPeipertJF, et al.Comparison of contraceptive use between the contraceptive CHOICE project and state and national data. Contraception2011; 83: 479–485. DOI: 10.1016/j.contraception.2010.10.001
44.
CohenJ. A power primer. Psychol Bull1992; 112: 155–159. DOI: 10.1037//0033-2909.112.1.155
45.
RutsteinSORojasG. Guide to DHS statistics. Calverton, MD: ICF; 2006.
46.
InternationalI. Demographic and health survey sampling and household listing manual. Calverton, MD: ICF International; 2012.
47.
GebregziabherMDaiLVrana-DiazC, et al.Gender disparities in receipt of HIV testing results in six sub-Saharan African countries. Health Equity2018; 2: 384–394. DOI: 10.1089/heq.2018.0060
48.
TymejczykOBrazierEYiannoutsosC, et al.HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries. PLOS Med2018; 15: e1002534. DOI: 10.1371/journal.pmed.1002534
ShanksLKlarkowskiDO’BrienDP. False positive HIV diagnoses in resource limited settings: operational lessons learned for HIV programmes. PLoS ONE2013; 8: e59906. DOI: 10.1371/journal.pone.0059906
51.
AkullianANMukoseALevineGA, et al.People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda. J Int AIDS Soc2016; 19: 20171. DOI: 10.7448/IAS.19.1.20171
52.
PisaniELazzariSWalkerN, et al.HIV surveillance: A global perspective. JAIDS J Acquired Immune Deficiency Syndromes2003; 32(Suppl 1): S3–S11.
53.
MandaSMasenyetseLCaiB, et al.Mapping HIV prevalence using population and antenatal sentinel-based HIV surveys: a multi-stage approach. Popul Health Metrics2015; 13: 22. DOI: 10.1186/s12963-015-0055-z
54.
BrookmeyerR. Measuring the HIV/AIDS epidemic: approaches and challenges. Epidemiologic Rev2010; 32: 26–37. DOI: 10.1093/epirev/mxq002
55.
OumaJJefferyCValadezJJ, et al.Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda. BMC Public Health2020; 20: 379. DOI: 10.1186/s12889-020-8436-z
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
