Impact of New WHO Growth Standards on the Prevalence of Acute Malnutrition and Operations of Feeding Programs - Darfur, Sudan, 2005-2007 by ProQuest

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									Vol. 58 / No. 21                                                MMWR                                                                        591


   In 2006, most new HIV infections in the United States,            MR Irizarry, Puerto Rico Dept of Health; J Prejean, Div of HIV/
including among Hispanics, occurred in persons aged 13–29            AIDS Prevention Surveillance and Epidemiology, M Ayala-Perales,
years (7). In contrast, most new HIV infections in Puerto Rico       and J Andia, Div of HIV/AIDS Prevention Intervention Research
occurred among persons aged 30–39 years. This age group had          and Support, National Center for HIV/AIDS, Viral Hepatitis, STD,
the highest rates of new HIV infection in both Puerto Rico           and TB Prevention, CDC.
and the United States; however, the incidence rate in Puerto         References
                                                                      1. CDC. HIV/AIDS surveillance report, 2006. Atlanta, GA: US
Rico (103.6 per 100,000 population) was 2.4 times the rate in            Department of Health and Human Services, CDC; 2008. Report no.
the United States (42.6) (6). One possible explanation for the           18. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/
higher rates in this age group in Puerto Rico might be related           reports/2006report/default.htm.
to injection-drug use. Persons commonly begin using non-              2. Karon JM, Song R, Kaplan E, Brookmeyer R, Kaplan EH, Hall
                                                                         HI. Estimating HIV incidence in the United States from HIV/
injection drugs and progress to injection-drug use. However,             AIDS surveillance data and biomarker HIV test results. Stat Med
further investigation is needed to test that hypothesis and fully        2008;27:4617–33.
understand the reasons for difference in the rates.                   3. Green TA. Using surveillance data to monitor trends in the AIDS epi-
                                                                         demic. Stat Med 1998;17:143–54.
   The findings in this report are subject to at least two limita-    4. Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution
tions. The classification of cases reported without a risk factor        of the national HIV/AIDS surveillance data: an alternative approach.
for transmission was based on a model incorporating random               Public Health Rep 2008;123:618–26.
                                                                      5. CDC. Bridged-race Vintage 2006 postcensal population estimates for
variations to impute missing values (4). Although multiple               July 1, 2000–July 1, 2006, by year, county, single-year of age, bridged-
imputation procedures are designed to maintain associations              race, Hispanic origin, and sex. Available at http://www.cdc.gov/nchs/
within the data, the degree of uncertainty introduced by this            about/major/dvs/popbridge/datadoc.htm#vintage2006.
imputation procedure is unknown. Second, the stratified               6. Hall HI, Song R, Rhodes P, et al; HIV Incidence Surveillance
                                                                         Group. Estimation of HIV incidence in the United States. JAMA
extrapolation approach to HIV incidence estimation is based              2008;300:520–9.
on several key assumptions, including that information on             7. CDC. Subpopulation estimates from the HIV incidence surveillance
previous tests and BED results were missing at random, that              system—United States, 2006. MMWR 2008;57:985–9.
                                                                      8. Espinoza L, Hall HI, Selik RM, Hu X. Characteristics of HIV infection
testing behavior has not changed substantially over several              among Hispanics, United States 2003–2006. J Acquir Immune Defic
years, that testing and infection are independent, and that              Syndr 2008;49:94–101.
information on previous testing is accurate (2). Concerns have        9. US Census Bureau. United States–States; and Puerto Rico. GCT-PH1.
                                                                         Population, housing units, area, and density: 2000 data set. Census 2000
been raised about the accuracy of the BED test, which appeared           summary file 1 (SF 1) 100-percent data. Available at http://factfinder.
to result in overestimation of recent HIV infections in Africa           census.gov.
and Thailand (10). The implications of these assumptions on          10. UNAIDS. Statement on the use of the BED assay for the estimation
incidence estimation have been discussed extensively (2,6)               of HIV-1 incidence for surveillance or epidemic monitoring: report of
                                                                         a meeting of the UNAIDS Reference Group for Estimates, Modeling
   The HIV epidemic in Puerto Rico is notably different from             and Projections. Athens, Greece: UNAIDS; 2005. Available at http://
the epidemic in the United States overall and among Hispanics            www.epidem.org/publications/bed%20statement.pdf.
in the United States (1,6–8). CDC supports prevention efforts
that target populations at greatest risk in Puerto Rico, including
injection-drug users, women who have high-risk heterosexual
contact, men who engage in male-to-male sexual contact,                Impact of New WHO Growth
and youths. To address transmission of HIV infection among
injection-
								
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