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Using serial cross-sectional surveys to create a retrospective nested cohort to determine HIV incidence from 20 U.S. Cities - 2008-2019.

AIDS 2023 September 13
OBJECTIVE: To estimate HIV incidence using successive cross-sectional surveys by creating retrospective nested cohorts among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexually active persons (HET).

DESIGN: Cohorts were created among participants who had at least one repeat observation across four surveillance cycles from National HIV Behavioral Surveillance in 20 U.S. cities.

METHODS: Repeat participants were identified using a combination of date of birth, race/ethnicity, metropolitan statistical area, and gender. The analysis was limited to participants who tested negative for HIV at baseline and were assumed to be at-risk between cycles. We calculated person-years at risk from the individual time between cycles and used the total number of seroconversions to estimate incidence and a Poisson distribution to approximate variance. Rate ratios were calculated by age, gender, race/ethnicity, and region.

RESULTS: From 2008 to 2019, successive surveys recaptured nested cohorts of 1,747 MSM, 3,708 PWID, and 1,396 HET. We observed an incidence rate of 2.5 per 100 person-years (95% confidence interval [CI]: 2.1 to 2.8) among MSM; 0.6 per 100 person-years (95% CI: 0.5 to 0.7) among PWID; and 0.3 per 100 person-years (95% CI: 0.1-0.4) among HET. HIV incidence was higher among younger MSM, Black MSM (compared to white MSM) and PWID residing in the South and Territories (compared to the Midwest).

CONCLUSIONS: These estimates are consistent with previously published incidence estimates from prospective cohort studies among these populations. Using repeat cross-sectional surveys to simulate a cohort, may serve as another strategy in estimating HIV incidence.

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