Study of bias in antenatal clinic HIV-1 surveillance data in a high contraceptive prevalence population in sub-Saharan Africa
Study of bias in antenatal clinic HIV-1 surveillance data in a high contraceptive prevalence population in sub-Saharan Africa
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DOI：
10.1097/00002030-200203080-00017
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发表时间：
2002-03-08
期刊：
影响因子：
3.8
通讯作者：
Caraël, M
中科院分区：
文献类型：
--
作者：
Gregson, S;Terceira, N;Caraël, M
目的：描述模式，来源和后果的偏见在产前诊所（ANC）艾滋病毒流行率估计在一个高避孕率population.Background：艾滋病毒监测在非洲依赖于孕妇参加ANC的数据。孕妇艾滋病毒估计数低估了低收入、高生育率人口中女性感染率。在高避孕药具使用率，延迟首次性行为的人群中的偏见仍然没有描述。设计和方法：比较津巴布韦农村地区的平行横断面人群和产前调查数据，其中60%的妇女是最近的避孕药具使用者。（25.7%; n = 576）和所有女性（25.5%; n = 5138）在15-44岁年龄范围内相似。与高生育率人口一样，年轻孕妇的艾滋病毒感染率较高，年长孕妇的感染率较低，但由于性活动延迟，交叉点出现得较晚。由于艾滋病毒相关的不孕症，艾滋病毒在老年人中的低报率因艾滋病毒感染减少和避孕药具使用者的产前护理频率降低而有所缓解。当地ANC HIV患病率估计值较低[21.2%; n = 1215;与一般人群中孕妇相比的风险比，0.8; 95%置信区间（CI），0.7-1.0]，可能是因为包括了来自更偏远地区的妇女。ANC估计夸大了艾滋病毒的相对风险，在更多的受教育妇女（年龄调整的比值比，1.1; 95%CI，0.8-1.4与0.7; 95%CI，0.6-0.9）。结论：ANC估计低估了女性艾滋病毒感染率在这一低生育率的人口，但在这里，主要原因不是选择孕妇。ANC估计需要控制避孕药具使用和首次性行为年龄的调整程序。(C)2002年利平科特威廉姆斯威尔金斯。
Objective: To describe patterns, sources and consequences of bias in antenatal clinic (ANC) HIV prevalence estimates in a high contraceptive prevalence population.Background: HIV surveillance in Africa relies on data from pregnant women attending ANCs. HIV estimates from pregnant women understate female infection levels in low income, high fertility populations. Bias in high contraceptive use, delayed sexual debut populations remains undescribed.Design and method: Comparison of parallel cross-sectional population and antenatal survey data from rural Zimbabwe, where 60% of women are recent contraceptive users.Results: HIV prevalence in recently pregnant women (25.7%; n = 576) and all women (25.5%; n = 5138) is similar over the age-range 15-44 years. As in high fertility populations, HIV prevalence is higher in pregnant women at young ages and lower at older ages but the crossover point occurs later due to delayed sexual activity. HIV understatement at older ages due to HIV-associated infertility is mitigated by less HIV infection and less frequent ANC attendance in contraceptive users. The local ANC HIV prevalence estimate is lower [21.2%; n = 1215; risk ratio versus pregnant women in the general population, 0.8; 95% confidence interval (CI), 0.7-1.0], possibly because women from more remote areas are included. ANC estimates overstate the relative risk of HIV in more educated women (age-adjusted odds ratio, 1.1; 95% Cl, 0.8-1.4 versus 0.7; 95% Cl, 0.6-0.9).Conclusions: ANC estimates understate female HIV prevalence in this low fertility population but, here, the primary cause is not selection of pregnant women. ANC estimate adjustment procedures that control for contraceptive use and age at first sex are needed. (C) 2002 Lippincott Williams Wilkins.