scientific sessions 2015: hiv estimations and projections 2015
TRANSCRIPT
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HIV estimations and projections; an overview of the methodology used in 2015
Dr K.A.M. Ariyaratne Consultant Venereologist | Coordinator Strategic Information
National STD/AIDS Control Programme, Sri Lanka
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Objective of this Presentation
• An Overview of the Current HIV estimation method
• What data and assumptions used for Sri Lanka during 2015
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Estimated number of adults and children newly infected with HIV 2013
Middle East & North Africa25 000
[14 000 – 41 000]
Sub-Saharan Africa1.5 million
[1.3 million – 1.6 million]
Eastern Europe & Central Asia
110 000 [86 000 – 130 000]
Latin America94 000
[71 000 – 170 000]
Caribbean12 000
[9400 – 14 000]
Total: 2.1 million [1.9 million – 2.4 million]
Asia and the Pacific350 000
[250 000 – 510 000]
North America and Western and Central Europe 88 000
[44 000 – 160 000]
In 2013 there were 2.1 million new HIV infections
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Why do we need HIV estimations?
• To provide HIV programme managers with estimated numbers relevant to HIV epidemic
• To use in strategic planning for prevention and care services
• For advocacy purposes: numbers infected, numbers dying
• For impact assessment e.g. Expansion of ART programme
• For global reporting/Comparing country Scenarios
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Loss of patients in the AIDS treatment cascade
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10th of July 2015
Software used for HIV estimations
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About the Spectrum Software• Software developed by Avenir Health (Futures Institute)
and East-West Center. Updated routinely
• Guidance from UNAIDS Reference Group on Estimates Modelling and Projections www.epidem.org
• Meetings to consider issues and refine• Engage with research institutes and individuals to answer
specific questions
• Methods published in peer-reviewed journals every other year
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Full model for R-Spline and R-Trend is same except for r(t) calculation
8 Source: East West Center and Futures Institute 2013
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Need Quality Data and Good Assumptions
garbage in, garbage out
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Outline of the Estimation Process
Demographic Data
Program Statistics
Epidemic Patterns
Surveillance and Survey Data
Demographic and Epidemic Calculations
• Mother-to-child transmission• Child model• Adult model
Prevalence / incidence trend
Results• Number HIV+• New Infections
• AIDS deaths• Need for ART
• Need for PMTCT
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Step 1. Creating a projection
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Step 2. ART elibgibility Criteria
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Step 3. HIV Programme Statistics
• Programme Statistics
1. PMTCT data
2. ART data
3. Child treatment data
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Cont., HIV Programme Statistics
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Step 4. Calculating Incidence
EPP (Estimation and Projection Package) with Adult (15-49) used.
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4.1 Incidence: Configuration1. Define the epidemic structure.
1. Concentrated /Low level epidemic
2. Define the sub-population characteristics1. Estimated population size 2. Whether people are likely to move in and out of this
sub-population3. Enter the estimated time (in years) that a person
spends in that sub-population.
HIV sentinel survey and IBBS data used.
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4.2 Sub-populations
1. FSW2. MSM3. Drug users4. Client of FSW5. Male Remaining6. Female Remaining
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4.3 Entering surveillance data
HIV sentinel survey and IBBS data used.
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4.4 Sub-population sizes
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4.5 Sub-population - Turn overs
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4.6 Sub-population - Turn overs• Following subpopulations were included
1. Drug Users (time in DU 10 years → male remaining pop.)
2. MSM (No turn over)3. Sex worker clients (time in group 7.5 yrs →
male rem. Pop)4. Sex workers (Time in group 5 yrs → female
remain pop)5. Male remaining population (NA)6. Female remaining population (NA)
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4.7 Incidence: Curve fitting• Spectrum 2015 offers four fitting methods
• R-Spline• R-Trend• EPP Classic• Workbook
• One-click fitting• Fit all
• Allows multiple projections to be fit
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4.8 Models available in EPP 2015
• R-Spline (default)• Applies a set of smooth mathematical functions to give
smoother incidence curves• R-Trend
• Draws on past experience with trends in r observed in actual epidemics to produce a smooth curve
• EPP Classic• A four parameter model that is useful in low data
situations and produces an epidemic that rises and plateaus
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Curve generated for MSM
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Calibrating the curves
• FSW no calibration done• Clients of sex workers FSW rate down calibrated
by 0.5• MSM up calibrated by a factor of 1.2• DU no calibrations• Male remaining pop- Urban ANC prevalence used
with a down calibration by a factor of 0.5• Female remaining pop -Urban ANC prevalence
used with a down calibration by a factor of 0.5
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Shapes of final curves fitted
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Getting Results with Spectrum
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Reported Vs. Estimated numbers
Reported Numbers - 2014
• Number living with HIV 1737 (Reported – Deaths) (53% of est.)
• New infections in 2014 228
• Deaths in 2014 26
• Adult HIV prevalence 0.03%
Estimated numbers - 2014
• Number living with HIV 3300
• New infections in 2014 <500
• Deaths in 2014 <200
• Adult HIV prevalence <0.1%
KAM Ariyaratne/ National STD/AIDS Control Programme/21.09.2015
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Outputs1. HIV pop by risk groups
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Outputs: 2. New HIV infections.
Too many DU new infections than actual data
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Summary
• Spectrum software used in the recent HIV estimation
• Software is getting improved over the time and subjected
to very frequent software updates
• Methodology is less sensitive to very low prevalent
epidemic
• Better programmatic data, surveillance data and beter
assumptions will produce reasonable estimates
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Thank you !