Dataset Information

The Estimation and Projection Package Age-Sex Model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.

ABSTRACT: OBJECTIVES:Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA). DESIGN:Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data. METHODS:We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form for the HIV transmission rate, termed 'r-hybrid', which combines a four-parameter logistic function for the initial epidemic growth, peak, and decline followed by a first-order random walk for recent trends after epidemic stabilization. We fitted the r-hybrid model along with previously developed r-spline and r-trend models to HIV prevalence data from household surveys and ANC-SS in 177 regions in 34 SSA countries. We used leave-one-out cross validation with household survey HIV prevalence to compare model predictions. RESULTS:The r-hybrid and r-spline models typically provided similar HIV prevalence trends, but sometimes qualitatively different assessments of recent incidence trends because of different structural assumptions about the HIV transmission rate. The r-hybrid model had the lowest average continuous ranked probability score, indicating the best model predictions. Coverage of 95% posterior predictive intervals was 91.5% for the r-hybrid model, versus 87.2 and 85.5% for r-spline and r-trend, respectively. CONCLUSION:The EPP-ASM and r-hybrid models improve consistency of EPP and Spectrum, improve the epidemiological assumptions underpinning recent HIV incidence estimates, and improve estimates and short-term projections of HIV prevalence trends. Countries that use general population survey and ANC-SS data to estimate HIV epidemic trends should consider using these tools.

SUBMITTER: Eaton JW

PROVIDER: S-EPMC6919231 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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The Estimation and Projection Package Age-Sex Model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.

Eaton Jeffrey W JW Brown Tim T Puckett Robert R Glaubius Robert R Mutai Kennedy K Bao Le L Salomon Joshua A JA Stover John J Mahy Mary M Hallett Timothy B TB

AIDS (London, England) 20191201

<h4>Objectives</h4>Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA).<h4>Design</h4>Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data.<h4>Methods</h4>We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form for the HIV transmission rate, termed 'r-hybrid', which combines a four-paramete ...[more]

PMID: 31800403

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Project description:BackgroundTotal domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. We describe the trends of investments in malaria-related research in sub-Saharan Africa and compare investment with national disease burden to identify areas of funding strength and potentially neglected populations. We also considered funding for malaria control.MethodsResearch funding data related to malaria for 1997-2013 were sourced from existing datasets, from 13 major public and philanthropic global health funders, and from funding databases. Investments (reported in US$) were considered by geographical area and compared with data on parasite prevalence and populations at risk in sub-Saharan Africa. 45 sub-Saharan African countries were ranked by amount of research funding received.FindingsWe found 333 research awards totalling US$814·4 million. Public health research covered $308·1 million (37·8%) and clinical trials covered $275·2 million (33·8%). Tanzania ($107·8 million [13·2%]), Uganda ($97·9 million [12·0%]), and Kenya ($92·9 million [11·4%]) received the highest sum of research investment and the most research awards. Malawi, Tanzania, and Uganda remained highly ranked after adjusting for national gross domestic product. Countries with a reasonably high malaria burden that received little research investment or funding for malaria control included Central African Republic (ranked 40th) and Sierra Leone (ranked 35th). Congo (Brazzaville) and Guinea had reasonably high malaria mortality, yet Congo (Brazzaville) ranked 38th and Guinea ranked 25th, thus receiving little investment.InterpretationSome countries receive reasonably large investments in malaria-related research (Tanzania, Kenya, Uganda), whereas others receive little or no investments (Sierra Leone, Central African Republic). Research investments are typically highest in countries where funding for malaria control is also high. Investment strategies should consider more equitable research and operational investments across countries to include currently neglected and susceptible populations.FundingRoyal Society of Tropical Medicine and Hygiene and Bill & Melinda Gates Foundation.

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Dataset Information

The Estimation and Projection Package Age-Sex Model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.

Publications

The Estimation and Projection Package Age-Sex Model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.

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