Abstract
AbstractMonitoring progress towards the UNAIDS ‘first 90’ target requires accurate estimates of levels of diagnosis among people living with HIV (PLHIV), which is often estimated using self-report. We conducted a systematic review and meta-analysis quantifying under-reporting of known HIV-positive status using objective knowledge proxies. Databases were searched for studies providing self-reported and biological/clinical markers of prior knowledge of HIV-positive status among PLHIV. Random-effects models were used to derive pooled estimates of levels of under-reporting. Thirty-two estimates from 26 studies were included (41,465 PLHIV). The pooled proportion under-reporting known HIV-positive status was 20% (95% confidence interval 13–26%, I2 = 99%). In sub-group analysis, under-reporting was higher among men who have sex with men (32%, number of estimates [Ne] = 10) compared to the general population (9%, Ne = 10) and among Black (18%, Ne = 5) than non-Black (3%, Ne = 3) individuals. Supplementing self-reported data with biological/clinical proxies may improve the validity of the ‘first 90’ estimates.
Funder
National Institutes of Health
Medical Research Council
Fonds de Recherche du Québec - Santé
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Public Health, Environmental and Occupational Health,Social Psychology
Reference62 articles.
1. WHO. Global Health Observatory (GHO) data. https://www.who.int/gho/hiv/en/. Accessed 3 Jan 2020.
2. 90-90–90. An ambitious treatment target to help end the AIDS epidemic. UNAIDS. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf. Accessed 17 June 2019.
3. Understanding fast-track. Accelerating action to end the epidemic by 2030. https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf. Accessed 16 March 2020.
4. Rodger A, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316:171.
5. Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6. https://doi.org/10.1097/QAD.0b013e328351f73f.