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Estimating and Projecting National HIV/AIDS Epidemics UNAIDS Reference Group on Estimates, Models and Projections
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Approach to Estimates and Projections Surveillance data EPP/Concentrated epidemic spreadsheet Adult HIV prevalence UN Pop Division population estimates UNAIDS epidemic patterns Spectrum Number infected New infections AIDS deaths
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Standard Approach Incidence Prevalence Mortality New infections # HIV+ AIDS deaths
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Spectrum Approach Prevalence t Population t HIV+ t New infections t-1,t Non-AIDS deaths of HIV t-1,t AIDS deaths t-1,t HIV+ t-1
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Spectrum: Standard epidemic patterns Sex ratio of prevalence Age distribution of infection Progression from infection to death Adults Children Mother-to-child transmission Fertility reduction
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Ratio of Female to Male Prevalence – Generalized Epidemics Mutasa Village 1998 Masaka Rakai trading center 1990 Mwanza urban 90-91 Mwanza roadside 90-91 Zambia rural 1999 Mutasa Estate 1998 Rwanda 1986 Uganda 1988 Zambia DHS
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Ratio of Female to Male Prevalence – Generalized Epidemics Kenya AIDS Ethiopia AIDS Tanzania AIDS
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Ratio of Female to Male Prevalence – Generalized Epidemics
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Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics Guatemala Panama Mexico Brazil Thailand Peru
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Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics Guatemala Panama Mexico Brazil Thailand Peru
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Sex ratio of infection
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Sex Ratio for Concentrated Epidemics Sex ratio can be calculated by spreadsheet and EPP for concentrated epidemics This ratio can be transferred to Spectrum to replace the default pattern
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Age-Specific Prevalence - Males
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Ratio to prevalence at 25-29 - Males
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Age-Specific Prevalence - Females
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Ratio to prevalence at 25-29 - Females
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Age Distribution of Cumulative Reported AIDS Cases - Female
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Age Distribution of Cumulative Reported AIDS Cases - Male
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Age distribution of infection
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Adult HIV Prevalence – Southern Mozambique
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Adult HIV Prevalence – Southern Mozambique and Sex Ratio of Prevalence
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HIV Incidence – Southern Mozambique
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Male Population by Age in Mozambique
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HIV+ Males by Age in Southern Mozambique
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New Male HIV Infections by Age in Southern Mozambique
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New Male AIDS Cases by Age in Southern Mozambique
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Progression to AIDS death Median = 9.4Median = 8.6
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Progression to AIDS death
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MTCT and fertility Mother-to-child transmission of HIV Default value = 32 percent Can be changed as PMTCT programs scale-up Fertility change due to HIV infection 15-19 = 50% increase 20-49 = 20% decrease
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Anti-retroviral therapy Can specify the percentage of population in need of ARV that receives it Population in need = HIV+ within two years of AIDS death without ARV Assumption : percent of those on ARV surviving to the following year Assumption : effect of ARV on prevalence
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Percent Surviving on ARVs by Annual Survival Rate
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Effect of ARV on Prevalence by Value of Effect Assumption
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Orphan Estimates Orphan: a child under the age of 15 that has lost one or both parents Maternal, paternal, dual, total AIDS, non-AIDS, total
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