Progress towards ending the AIDS epidemic
The overarching goal of the global AIDS response is to reduce the number of people newly infected to less than 200 000 in 2030. Monitoring the rate of people newly infected over time measures the progress towards achieving this goal. This indicator is one of the 10 global indicators in the WHO consolidated strategic information guidelines.
Number of people newly infected during the reporting period
Total number of uninfected population (or person-years exposed)
Rate: (Numerator x 1000)/denominator
Methods for monitoring incidence can vary depending on the epidemic setting and are typically categorized either as direct or indirect measures. Direct measurement at a population level is preferred but can often be difficult to obtain. As a result, most if not all countries rely on indirect measures or triangulate direct and indirect methods.
Strategies for directly measuring HIV incidence include longitudinal follow-up and repeat testing among individuals who do not have HIV infection and estimation using a laboratory test for recent HIV infection and clinical data in the population. Longitudinal monitoring is often costly and difficult to perform at a population level. Laboratory testing of individuals to determine the recency of infection also raises cost and complexity challenges since a nationally representative population-based survey is typically required to obtain estimates.
Indirect methods most frequently rely on estimates constructed from mathematical modelling tools, such as Spectrum or the AIDS Epidemic Model. These models may incorporate geographical and population-specific HIV surveys, surveillance, case reporting, mortality, programme and clinical data and, in some instances, assumptions about risk behaviour and HIV transmission. In some instances, countries may wish to triangulate these data with other sources of estimates of the number of people newly infected, including from serial population-based HIV prevalence estimates or estimates of HIV prevalence in young, recently exposed populations.
Note that case-based surveillance systems capturing newly reported people acquiring HIV infection should not be used as a direct source of estimating the number of people newly infected with HIV in the reporting year. Because of reporting delays and underdiagnosis, newly reported cases may not reflect the actual rate of people becoming newly infected. This information may be useful, however, for triangulation or validation purposes, especially when combined with tests for the recency of HIV infection.
Disaggregated data reported for the numerator should be used to monitor progress towards eliminating new child infections and reducing the number of new HIV infections among adolescent girls and young women to below 100 000 per year.
- Sex (male and female)
- Age (0–14, 15–24, 15–49 and 50+ years)
- Cities and other administrative areas of epidemiologic importance
Estimates of the rate of new infections and changes over time in this rate are considered the gold standard for monitoring programme impact. However, even in high-risk populations, people becoming newly infected with HIV is a relatively rare event. The accuracy of estimates of incidence and changes in this rate over time can therefore be uncertain. Such uncertainty should be reported when using HIV incidence rates to monitor programme impact, especially when disaggregated by sex and age and for key populations or in specific geographical areas. Countries should use caution when applying incidence rates from small studies to a population more generally.
Consolidated strategic information guidelines for HIV in the health sector. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/164716/1/9789241508759_eng.pdf?ua=1).
Spectrum software. Glastonbury (CT): Avenir Health; 2019 (http://www.avenirhealth.org/software-spectrum.php).
BI.3 New HIV infections, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).