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Study has important implications for using clinical data to understand underlying population-level dynamics of the epidemic
Routine data from medical records are increasingly recognized as an important source of information about the HIV epidemic, particularly with the scale-up of HIV care and treatment in low-resource settings where population-level surveillance is limited. However, the extent to which those enrolled in HIV care are representative of the underlying population of people living with HIV (PLWH) is often unknown.
In a paper published in the International Journal of STD & AIDS, CUNY SPH alumna Anna Mageras, doctoral student Ellen Brazier, and faculty members Heidi Jones, Elizabeth Kelvin, and Denis Nash assessed the extent to which the characteristics of PLWH in the Central Africa cohort of the International epidemiologic Databases to Evaluate AIDS (CA-IeDEA) are similar to those of PLWH identified in the Demographic and Health Surveys (DHS).
The study examined data on 28,478 patients enrolled in HIV care at clinics in Burundi and Rwanda that participate in the IeDEA research consortium, comparing key socio-demographic and clinical characteristics—age, marital status, and body mass index (BMI) by sex, as well as women’s pregnancy status—among the CA-IeDEA cohorts against the PLWH populations reflected in national DHS data in these two countries at multiple points in time. The analysis found that patients in the CA-IeDEA cohorts were broadly representative of PLWH in urban areas of the two countries, with a slightly higher proportion of single men in the CA-IeDEA cohort, particularly in Burundi, where one of the participating sites does extensive outreach among sexual minority populations. Among women, the age and marital status were similar for the CA-IeDEA cohort and the DHS data. However, the proportion of women over age 49 and men over age 59 included in the CA-IeDEA cohort increased over time in both countries—age groups that are not included in the DHS. Also noteworthy, in both countries, the proportion of patients who were underweight decreased over time, suggesting improvements in the immunological status of those enrolled in HIV care.
“While ongoing efforts to strengthen surveillance systems remain crucial, the findings from this analysis underscore how combining data from clinical cohorts and population representative survey data can provide important insights to help guide efforts to end the HIV epidemic,” notes Dr. Jones.
