Improvements in Spectrum's fit to program data tool

Mahiane, Séverin Guy; Marsh, Kimberly; Grantham, Kelsey L.; Crichlow, Shawna; Cáceres, Karen; Stover, John

doi:10.1097/qad.0000000000001359

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…It is important that mathematical models of the impact of ART reflect the uncertainty regarding the ART mortality rates that apply locally. Ideally models should be calibrated to local mortality data to reduce this uncertainty [3,43], but when such data are not available and these IeDEA estimates are used, confidence intervals around model outputs should reflect the standard deviations of the random effects terms estimated here. Future analyses should aim to reduce the variation of these random effects, for example by regressing on country GDP per capita and on rates of viral suppression, factors that are likely to account for much of the variation in mortality within regions.…”

Section: Discussionmentioning

confidence: 99%

Global variations in mortality in adults after initiating antiretroviral treatment

Johnson

Anderegg

Zaniewski

et al. 2019

Aids

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a,b , for the International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration Background: UNAIDS models use data from the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration in setting assumptions about mortality rates after antiretroviral treatment (ART) initiation. This study aims to update these assumptions with new data, to quantify the extent of regional variation in ART mortality and to assess trends in ART mortality. Methods: Adult ART patients from Africa, Asia and the Americas were included if they had a known date of ART initiation during 2001-2017 and a baseline CD4 þ cell count. In cohorts that relied only on passive follow-up (no patient tracing or linkage to vital registration systems), mortality outcomes were imputed in patients lost to follow-up based on a meta-analysis of tracing study data. Poisson regression models were fitted to the mortality data. Results: 464 048 ART patients were included. In multivariable analysis, mortality rates were lowest in Asia and highest in Africa, with no significant differences between African regions. Adjusted mortality rates varied significantly between programmes within regions. Mortality rates in the first 12 months after ART initiation were significantly higher during 2001-2006 than during 2010-2014, although the difference was more substantial in Asia and the Americas [adjusted incidence rate ratio (aIRR) 1.43, 95% CI: 1.22-1.66] than in Africa (aIRR 1.07, 95% CI: 1.04-1.11).

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Section: Discussionmentioning

confidence: 99%

Global variations in mortality in adults after initiating antiretroviral treatment

Johnson

Anderegg

Zaniewski

et al. 2019

Aids

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“…Estimation of incidence using the CSAVR tool in Spectrum has been previously described [12,33,34]. Briefly, routine reporting of new diagnoses, mean CD4 at diagnosis and AIDS deaths are used for model fitting.…”

Section: Spectrummentioning

confidence: 99%

Monitoring progress towards the first UNAIDS 90-90-90 target in key populations living with HIV in Norway

et al. 2020

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Background In line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, Norway aims for at least 90% of people living with HIV (PLHIV) to know their HIV-status. We produced current estimates of the number of PLHIV and undiagnosed population in Norway, overall and for six key subpopulations: Norwegian-born men who have sex with men (MSM), migrant MSM, Norwegian-born heterosexuals, migrant Sub-Saharan Africa (SSA)-born heterosexuals, migrant non-SSA-born heterosexuals and people who inject drugs. Methods We used the European Centre for Disease Prevention and Control (ECDC) HIV Modelling Tool on Norwegian HIV surveillance data through 2018 to estimate incidence, time from infection to diagnosis, PLHIV, and the number and proportion undiagnosed. As surveillance data on CD4 count at diagnosis were not collected in Norway, we ran two models; using default model CD4 assumptions, or a proxy for CD4 distribution based on Danish national surveillance data. We also generated alternative overall PLHIV estimates using the Spectrum AIDS Impact Model, to compare with those obtained from the ECDC tool. Results Estimates of the overall number of PLHIV in 2018 using different modelling approaches aligned at approximately 5000. In both ECDC models, the overall number undiagnosed decreased continuously from 2008. The proportion undiagnosed in 2018 was lower using default model CD4 assumptions (7.1% [95%CI: 5.3–8.9%]), than the Danish CD4 proxy (10.2% [8.3–12.1%]). This difference was driven by results for heterosexual migrants. Estimates for Norwegian-born MSM, migrant MSM and Norwegian-born heterosexuals were similar in both models. In these three subpopulations, incidence in 2018 was < 30 new infections, and the number undiagnosed had decreased in recent years. Norwegian-born MSM had the lowest estimated number of undiagnosed infections (45 [30–75], using default CD4 assumptions) and undiagnosed fraction (3.6% [2.4–5.7%], using default CD4 assumptions) in 2018. Conclusions Results allow cautious confidence in concluding that Norway has achieved the first UNAIDS 90–90-90 target, and clearly highlight the success of prevention strategies among MSM. Estimates for subpopulations strongly influenced by migration remain less clear, and future modelling should appropriately account for all-cause mortality and out-migration, and adjust for time of in-migration.

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“…Dado este proceso, donde los datos son inestables, esta metodología de estimaciones y proyecciones no es la alternativa óptima para representar la tendencia de los datos. En países con epidemias de muy bajo nivel, donde no se dispone de información sobre prevalencia de infección por VIH en poblaciones clave o de mayor vulnerabilidad y riesgo, la estimación de incidencia de VIH usando EPP no es recomendable 2 .…”

Section: Vih / Sidaunclassified

“…Es así, que la herramienta FPD fue diseñada por ONUSIDA como alternativa para modelar información usando datos más robustos obtenidos de los sistemas de vigilancia de VIH, datos de las estadísticas vitales (mortalidad), datos originados de la atención clínica de pacientes con VIH (como el recuento de linfocitos T CD4(+)s: LT CD4), datos de atención en mujeres embarazadas con infección por VIH y de niños y niñas (NNA) infectados 2 . Esta herramienta es la que se utilizó para el modelamiento chileno.…”

Section: Vih / Sidaunclassified

Estimaciones poblacionales sobre VIH en Chile 2017 SPECTRUM, ONUSIDA

Cáceres

Pino

2018

Rev. chil. infectol.

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Improvements in Spectrum's fit to program data tool

Cited by 9 publications

References 14 publications

Global variations in mortality in adults after initiating antiretroviral treatment

Global variations in mortality in adults after initiating antiretroviral treatment

Monitoring progress towards the first UNAIDS 90-90-90 target in key populations living with HIV in Norway

Estimaciones poblacionales sobre VIH en Chile 2017 SPECTRUM, ONUSIDA

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