Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda
Abstract Background National or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district levels; this leads to wide confidence intervals when estimating HIV prevalence at district level for programme monitoring and decision making. Health facility programm...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-020-8436-z |
| _version_ | 1818460116039499776 |
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| author | Joseph Ouma Caroline Jeffery Joseph J. Valadez Rhoda K. Wanyenze Jim Todd Jonathan Levin |
| author_facet | Joseph Ouma Caroline Jeffery Joseph J. Valadez Rhoda K. Wanyenze Jim Todd Jonathan Levin |
| author_sort | Joseph Ouma |
| collection | DOAJ |
| description | Abstract Background National or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district 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. |
| first_indexed | 2024-12-14T23:25:08Z |
| format | Article |
| id | doaj.art-cb1e9876545b419abf5c002f4c93ff69 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-14T23:25:08Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-cb1e9876545b419abf5c002f4c93ff692022-12-21T22:43:49ZengBMCBMC Public Health1471-24582020-03-0120111410.1186/s12889-020-8436-zCombining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in UgandaJoseph Ouma0Caroline Jeffery1Joseph J. Valadez2Rhoda K. Wanyenze3Jim Todd4Jonathan Levin5Division of Epidemiology and Biostatistics, School of Public Health, University of WitwatersrandMETRe Group, Department of International Health, Liverpool School of Tropical Medicine, Pembroke PlaceMETRe Group, Department of International Health, Liverpool School of Tropical Medicine, Pembroke PlaceDepartment of Disease Control and Environmental Health, Makerere University School of Public HealthDepartment of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDivision of Epidemiology and Biostatistics, School of Public Health, University of WitwatersrandAbstract Background National or regional population-based HIV prevalence surveys have small sample sizes at district or sub-district 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.http://link.springer.com/article/10.1186/s12889-020-8436-zCombiningBiasPopulation surveyHealth Information SystemHybrid Prevalence EstimateDistrict Health Information System |
| spellingShingle | Joseph Ouma Caroline Jeffery Joseph J. Valadez Rhoda K. Wanyenze Jim Todd Jonathan Levin Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda BMC Public Health Combining Bias Population survey Health Information System Hybrid Prevalence Estimate District Health Information System |
| title | Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda |
| title_full | Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda |
| title_fullStr | Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda |
| title_full_unstemmed | Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda |
| title_short | Combining national survey with facility-based HIV testing data to obtain more accurate estimate of HIV prevalence in districts in Uganda |
| title_sort | combining national survey with facility based hiv testing data to obtain more accurate estimate of hiv prevalence in districts in uganda |
| topic | Combining Bias Population survey Health Information System Hybrid Prevalence Estimate District Health Information System |
| url | http://link.springer.com/article/10.1186/s12889-020-8436-z |
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