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In Reply: Drs Hallett and Garnett and Mr Todd and colleagues raise legitimate concerns regarding the accuracy of the BED assay in estimating HIV incidence. The assay was developed to include all subtypes and recombinants, including those in Africa, but has previously overestimated HIV incidence and requires an adjustment factor to address misclassification.¹ For this reason, we focused our analysis on risk factors for recent infection. A large proportion of BED-misclassified infections occur in the year prior to testing,² which is recent from a risk factor standpoint.

Large population cohorts are the gold standard for measuring HIV incidence and they can examine demographic and behavioral risk factors for infection, yet they are not nationally based and over time annual HIV counseling and testing, prevention efforts, and interventional trials may reduce representativeness. Mathematically modeling incidence from prevalence data can effectively estimate national incidence but relies on assumptions, may have difficulty responding . . . [Full Text of this Article]

Jonathan Mermin, MD, MPH
jhm7@cdc.gov
Coordinating Office for Global Health
Centers for Disease Control and Prevention (CDC)–Kenya
Nairobi, Kenya

Joshua Musinguzi, MBChB, MSc
Ministry of Health
Kampala, Uganda

Wolfgang Hladik, MD, MSc
Global AIDS Program
CDC-Uganda
Entebbe, Uganda

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