Updates to the Spectrum model to estimate key HIV indicators for adults and children

Stover, John; Andreev, Kirill; Slaymaker, Emma; Gopalappa, Chaitra; Sabin, Keith; Velásquez, Claudia; Nakiyingi‐Miiro, Jessica; Crampin, Amelia C.; Lutalo, Tom; Herbst, Kobus; Gregson, Simon; Urassa, Mark

doi:10.1097/qad.0000000000000483

Cited by 73 publications

(76 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For the Zimbabwe country application, we used the national Spectrum/AIM model [19], which projects population size, mortality, and HIV prevalence and incidence based on data empirically collected from the country. Population by age and year, mortality by age and year, annual number of male births, and HIV incidence by age and year were exported from this Spectrum/AIM file into a national Zimbabwe DMPPT 2.0 file.…”

Section: Methodsmentioning

confidence: 99%

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

Kripke

Hatzold²,

Mugurungi

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

BackgroundZimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20–29 was examined.MethodsZimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10–19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20–29 with a corresponding increase in unit cost for these age groups.ResultsWhen circumcision coverage among men ages 20–29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario.ConclusionsAlthough increased investment in recruiting VMMC clients ages 20–29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

show abstract

Section: Methodsmentioning

confidence: 99%

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

Kripke

Hatzold²,

Mugurungi

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Input parameters and curve fits have been provided in S1 and S2 Appendices and S1 Fig. The historical ART and PMTCT (prevention of mother-to-child transmission of HIV) service statistics were imported from the nationally validated 2015 Spectrum/AIM (AIDS Impact Model) [12] file for each country.…”

Section: Methodsmentioning

confidence: 99%

Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets

Kripke

Reed²,

Hankins

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

BackgroundThe report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for World AIDS Day 2014 highlighted a Fast-Track Strategy that sets ambitious treatment and prevention targets to reduce global HIV incidence to manageable levels by 2020 and end the AIDS epidemic by 2030. The 90-90-90 treatment targets for 2020 call for 90% of people living with HIV to know their HIV status, 90% of people who know their status to receive treatment, and 90% of people on HIV treatment to be virally suppressed. This paper examines how scale-up of voluntary medical male circumcision (VMMC) services in four priority countries in sub-Saharan Africa could contribute to ending the AIDS epidemic by 2030 in the context of concerted efforts to close the treatment gap, and what the impact of VMMC scale-up would be if the 90-90-90 treatment targets were not completely met.MethodsUsing the Goals module of the Spectrum suite of models, this analysis modified ART (antiretroviral treatment) scale-up coverage from base scenarios to reflect the 90-90-90 treatment targets in four countries (Lesotho, Malawi, South Africa, and Uganda). In addition, a second scenario was created to reflect viral suppression levels of 75% instead of 90%, and a third scenario was created in which the 90-90-90 treatment targets are reached in women, with men reaching more moderate coverage levels. Regarding male circumcision (MC) coverage, the analysis examined both a scenario in which VMMCs were assumed to stop after 2015, and one in which MC coverage was scaled up to 90% by 2020 and maintained at 90% thereafter.ResultsAcross all four countries, scaling up VMMC is projected to provide further HIV incidence reductions in addition to those achieved by reaching the 90-90-90 treatment targets. If viral suppression levels only reach 75%, scaling up VMMC leads to HIV incidence reduction to nearly the same levels as those achieved with 90-90-90 without VMMC scale-up. If only women reach the 90-90-90 targets, scaling up VMMC brings HIV incidence down to near the levels projected with 90-90-90 without VMMC scale-up. Regarding cost, scaling up VMMC increases the annual costs during the scale-up phase, but leads to lower annual costs after the MC coverage target is achieved.ConclusionsThe scenarios modeled in this paper show that the highly durable and effective male circumcision intervention increases epidemic impact levels over those of treatment-only strategies, including the case if universal levels of viral suppression in men and women are not achieved by 2020. In the context of 90-90-90, prioritizing continued successful scale-up of VMMC increases the possibility that future generations will be free not only of AIDS but also of HIV.

show abstract

“…Survival on ART is based on data from IeDEA consortium sites which might not be representative of all public providersMore detail required than can be provided hereAll data inputs are availableComplete files with all input data can be downloaded from unaids.org. For those country files not publicly available, country team contact details can be requested from UNAIDSMetConceptual overview of the methodsSee Spectrum Quickstart guide and Spectrum manual at www.avenirhealth.org.Models are also fully described in published articles:[29–31,39–42,44,71]MetDescription of the stepsQuickstart guide describing steps to create the estimate files is available from www.avenirhealth.orgMetHow were candidate models evaluatedSee meeting reports at www.epidem.org http://www.epidem.org/sites/default/files/reports/TechnicalRefinementsforSpectrum%202013.pdfMetResults of model evaluations and sensitivity analysesSee meeting reports at www.epidem.org http://www.epidem.org/sites/default/files/reports/TechnicalRefinementsforSpectrum%202013.pdf…”

Section: Lessons Learnedmentioning

confidence: 99%

Producing HIV estimates: from global advocacy to country planning and impact measurement

Mahy

Brown

Stover

et al. 2017

Global Health Action

Self Cite

View full text Add to dashboard Cite

Background: The development of global HIV estimates has been critical for understanding, advocating for and funding the HIV response. The process of generating HIV estimates has been cited as the gold standard for public health estimates. Objective: This paper provides important lessons from an international scientific collaboration and provides a useful model for those producing public health estimates in other fields. Design: Through the compilation and review of published journal articles, United Nations reports, other documents and personal experience we compiled historical information about the estimates and identified potential lessons for other public health estimation efforts. Results: Through the development of core partnerships with country teams, implementers, demographers, mathematicians, epidemiologists and international organizations, UNAIDS has led a process to develop the capacity of country teams to produce internationally comparable HIV estimates. The guidance provided by these experts has led to refinements in the estimated numbers of people living with HIV, new HIV infections and AIDS-related deaths over the past 20 years.A number of important updates to the methods since 1997 resulted in fluctuations in the estimated levels, trends and impact of HIV. The largest correction occurred between the 2005 and 2007 rounds with the additions of household survey data into the models. In 2001 the UNAIDS models at that time estimated there were 40 million people living with HIV. In 2016, improved models estimate there were 30 million (27.6–32.7 million) people living with HIV in 2001. Conclusions: Country ownership of the estimation tools has allowed for additional uses of the results than had the results been produced by researchers or a team in Geneva. Guidance from a reference group and input from country teams have led to critical improvements in the models over time. Those changes have improved countries’ and stakeholders’ understanding of the HIV epidemic.

show abstract

Updates to the Spectrum model to estimate key HIV indicators for adults and children

Cited by 73 publications

References 16 publications

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets

Producing HIV estimates: from global advocacy to country planning and impact measurement

Contact Info

Product

Resources

About