Consensus Meeting for Improving the Quality of Laboratory Testing for HIV Surveillance Temporal Trends in the Inciden

1. Consensus Meeting for Improving the Quality ofLaboratory Testing for HIV Surveillance Temporal Trends in the Incidence of HIV Infection in Addis Ababa, 1995 to 2003Dawit Wolday, MD, PhDEHNRI/CDC Programme on HIV/STI & TBEthiopian Health and Nutrition Research InstituteAddis Ababa, Ethiopia

3. Previous studies have shown that age-specific changes in HIV prevalence can be used to estimate the incidence of HIV infection Young age (15-24 yrs) as proxy for recent infection in HIV prevalence surveys has been used to estimate HIV incidence Background

5. Do the declines noted in HIV prevalence, especially among young age groups, indicate also declines in new infections?

6. Training at CDC-Atlanta Lab Validation of BED incidence assay for HIV subtype C infection using panel of seroconverters sera with known dates of seroconvertion Transfer of the assay to EHNRI Use of BED assay for cross-sectional ANC samples from A.A. In future…for all samples available for QC Implementation of the incidence assay in Ethiopia: the steps

8. To estimate the trend in the incidence of HIV infection among women attending ANC in Addis Ababa between 1995 to 2003 using BED-CEIA incidence assay To compare the BED assay with age-specific incidence estimates derived from age-specific prevalence surveys [To compare the BED assay with models that estimate incidence] Objectives of the Study

9. Annual ANC-based seroprevalence surveys were conducted between 1995 and 2003 in Addis Ababa, Ethiopia About 300-350 consecutive samples were tested per site; 2 sites in 1995 and 4 sites from 1996 onwards; 5 sites in 2003 Samples collected from ANC sites were transported to ENARP/EHNRI laboratory and stored at -80oC; for 2003 samples were from QC Study Population

10. SEROPREVALENCE SURVEY: HIV testing was done by EIA Algorithm: Vironostika, if+ re-testing by Murex, WB for discordant Syphilis testing was done by RPR & TPHA/TPPA ENARP laboratory Participates in the CDC-MPEP, 2x/year INCIDENCE STUDY: All HIV positive samples were retrieved, thawed and tested with BED-CEIA incidence assay Specimens with a calculated standard OD (sample OD-negative control OD) of < 1.200 were retested in triplicate Retested specimens that had a mean standard OD of < 0.800 were considered as recent Laboratory investigations

11. Incidence rate calculation

12. Temporal trends in demographic characteristics of women attending ANC 1995-2003Addis Ababa, Ethiopia

16. Changes in A.A. surveillance [prevalence] Sites increased to 5 Decentralized – work transferred to A.A. Regional Lab QC at NRLA: 10 samples reported as negative by the AARL were found to be positive 2003 Incidence

17. The overall prevalence declined from 21% in 1995 to 12% in 2003 The prevalence of HIV declined significantly among young women aged 15 to 24 years between 1995 and 2003; no decline was noted for older ages Decline in the prevalence of HIV is supported by decline in the overall incidence as well as in the younger age group Summary

18. BED-CEIA incidence assay can be used to provide rapid and relatively inexpensive estimates of incidence, which are urgently needed for various programmes Need for further evaluation of the assay in other countries Conclusion

19. EHNRI Staff Hailu Meles Tsehaynesh Messele Ermias Hailu CDC-Ethiopia Yohannes Mengistu Makonnen Fekadu Tadesse Wuhib CDC-Atlanta Bharat S. Parekh Trudy Dobbs Acknowledgements

20. Thank you!!