Estimating and Projecting National HIV/AIDS Epidemics UNAIDS Reference Group on Estimates, Models and Projections.
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Estimating and Projecting National HIV/AIDS
EpidemicsUNAIDS Reference Group on
Estimates, Models and Projections
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
Standard Approach
Incidence
Prevalence
Mortality
New infections
# HIV+
AIDS deaths
Spectrum Approach
Prevalencet Populationt
HIV+t
New infectionst-1,t
Non-AIDS deaths of HIVt-1,t
AIDS deathst-1,t
HIV+t-1
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
Ratio of Female to Male Prevalence – Generalized Epidemics
0.00.20.40.60.81.01.21.41.61.82.0
0 5 10 15 20
Years Since Start of Epidemic
Mutasa Village 1998
Masaka
Rakai trading center 1990Mwanza urban 90-91
Mwanza roadside 90-91
Zambia rural 1999
Mutasa Estate 1998
Rwanda 1986
Uganda 1988Zambia DHS
Ratio of Female to Male Prevalence – Generalized Epidemics
0.00.20.40.60.81.01.21.41.61.82.0
0 5 10 15 20
Years Since Start of Epidemic
Kenya AIDS
Ethiopia AIDS
Tanzania AIDS
Ratio of Female to Male Prevalence – Generalized Epidemics
0.00.20.40.60.81.01.21.41.61.82.0
0 5 10 15 20
Years Since Start of Epidemic
Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0 5 10 15 20
Years Since Start of Epidemic
Guatemala
Panama
Mexico
Brazil
Thailand
Peru
Ratio of Female to Male Reported AIDS Cases – Concentrated Epidemics
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0 5 10 15 20
Years Since Start of Epidemic
Guatemala
Panama
Mexico
Brazil
Thailand
Peru
Sex ratio of infection
Ratio of female to male prevalence
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
0 5 10 15 20 25
Years since start of the epidemic
HeterosexualMSM/IDU
Age-Specific Prevalence - Males
0
5
10
15
20
25
30
35
40
45
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02
Ratio to prevalence at 25-29 - Males
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02
Ratio to prevalence at 25-29 - Males
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02Model
Age-Specific Prevalence - Females
0
5
10
15
20
25
30
35
40
45
50
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02
Ratio to prevalence at 25-29 - Females
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02
Ratio to prevalence at 25-29 - Females
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
15-19 20-24 25-29 30-39 40-49
Addis Ababa, 97Lusaka, 96Lusaka, 99Kisumu, 1997Cotonou, 1997Yaounde, 1997Ndola, 1997Mposhi, 96Mposhi, 99Masaka, 92-93Zambia, 01-02Model
Age Distribution of Cumulative Reported AIDS Cases - Female
0%
5%
10%
15%
20%
25%
30%
35%
15-19 20-24 25-29 30-34 35-39 40-44 45-49
AustraliaBarbadosCISEastern EuropeGuatemalaS AmericaN EuropeNANES AfricaSEAW AfricaW Europe
Age Distribution of Cumulative Reported AIDS Cases - Male
0%
5%
10%
15%
20%
25%
30%
35%
15-19 20-24 25-29 30-34 35-39 40-44 45-49
AustraliaBarbadosCISEastern EuropeGuatemalaS AmeicaN EuropeNANES AfricaSEAW AfricaW Europe
Age distribution of infection
Ratio of prevalence to prevalence at 25-29
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
MenWomen
Adult HIV Prevalence – Southern Mozambique
0
2
4
6
8
10
12
14
16
18
20
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Adult HIV Prevalence – Southern Mozambique and Sex Ratio of Prevalence
0
2
4
6
8
10
12
14
16
18
20
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 20100.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
HIV Incidence – Southern Mozambique
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Male Population by Age in Mozambique
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
HIV+ Males by Age in Southern Mozambique
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
New Male HIV Infections by Age in Southern Mozambique
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
New Male AIDS Cases by Age in Southern Mozambique
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Progression to AIDS deathCumulative proportion of adults progressing
from HIV infection to AIDS death
0.0
0.2
0.4
0.6
0.8
1.0
0 2 4 6 8 10 12 14 16 18 20Years since infection
FemaleMale
Median = 9.4Median = 8.6
Progression to AIDS deathCumulative proportion of children progressing
from HIV infection to AIDS death
0.0
0.2
0.4
0.6
0.8
1.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Age
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
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
Percent Surviving on ARVs by Annual Survival Rate
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Years
0.750.800.850.900.95
Effect of ARV on Prevalence by Value of Effect
Assumption
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1980 1985 1990 1995 2000 2005 2010
Preva
lence (%
)
1.00.40.0
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
Percent 15-19 never married
Percent of married women in
monogamous unions
Benin 2001 76.1 54.2 Botswana 1988 93.9 Burkina Faso 1998/99 65.2 45.3 Burundi 1987 93.2 88.3 Cameroon 1998 64.2 66.9 CAR 1994/95 57.7 71.5 Chad 1996/97 51.4 60.8 Comoros 1996 88.5 74.7 Cote d'Ivoire 1998/99 74.6 65.0 Eritrea 1995 62.4 92.9 Ethiopia 2000 70.0 86.4 Gabon 2000 77.6 78.0 Ghana 1998 83.6 77.3 Guinea 1999 53.9 46.3 Kenya 1998 83.3 83.7 Liberia 1986 64.0 61.9 Madagascar 1997 66.3 96.0 Malawi 2000 63.2 Mali 1995/1996 50.3 55.7 Mauritania 2000/01 72.3 88.4 Mozambique 1997 52.9 71.5 Namibia 1992 92.3 74.6 Niger 1998 38.1 62.2 Nigeria 1999 72.5 64.3 Rwanda 1992 90.2 85.6 Senegal 1997 71.0 51.4 Sudan 1990 84.1 79.6 Tanzania 1999 72.8 Togo 1998 80.1 57.2 Uganda 2000/01 67.7 67.3 Zambia 1996 72.7 82.9 Zimbabwe 1999 77.3
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