Laboratories Branch, MOHLTC, IMC – 2001 Estimates and projections of Estimates and projections of HIV infection among persons from HIV infection among persons from HIV HIV - - endemic countries in Ontario endemic countries in Ontario Robert S. Remis MD Department of Public Health Sciences University of Toronto ACCHO Research Summit April 28, 2006, Toronto, Ontario
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Laboratories Branch, MOHLTC, IMC – 2001
Estimates and projections of Estimates and projections of HIV infection among persons from HIV infection among persons from HIVHIV--endemic countries in Ontarioendemic countries in Ontario
Robert S. Remis MDDepartment of Public Health Sciences University of Toronto
ACCHO Research SummitApril 28, 2006, Toronto, Ontario
Laboratories Branch, MOHLTC, IMC – 2001
BackgroundBackground
• 1990-98: Anecdotal case reports and growing community concern
• Limited research and few data• HIV Endemic Task Force mandated an
epidemiologic assessment in November 1998• Completed in 1999; updated in 2003
Laboratories Branch, MOHLTC, IMC – 2001
Definition: HIVDefinition: HIV--endemicendemic
1. HIV prevalence in the general population >1% (may be 20% or more)
and 1. Heterosexual contact most important (>50%)
mode of transmission
Laboratories Branch, MOHLTC, IMC – 2001
Study mandateStudy mandate
• Characterize the incidence and prevalence of HIV infection among persons from HIV-endemic countries in Ontario
Laboratories Branch, MOHLTC, IMC – 2001
Methods: Model structureMethods: Model structure
Stage 1: Demographic modelEstimate population by sex and country of birth(and region of residence) from 1981 to 2002
Stage 2: HIV infection modelEstimate prevalence of HIV infection by sex andcountry of birth from 1981 to 2002
Laboratories Branch, MOHLTC, IMC – 2001
Methods: Model structureMethods: Model structure
Fitting model
• Model outputs compared to observed data (targets): AIDS incidence, AIDS-related deaths and HIV-infected mothers and infants
• HIV prevalence immigration factor adjusted to minimize the Goodness-of-fit statistic
Laboratories Branch, MOHLTC, IMC – 2001
Methods: Selection of countriesMethods: Selection of countries
• Category 1: Individual modelCountries with large population in Ontario or large number of AIDS cases
• Category 2: RegionalCountries with few immigrants in Ontario and few AIDS cases
• Category 3: Excluded
Laboratories Branch, MOHLTC, IMC – 2001
Methods: Selection of countriesMethods: Selection of countries
Results: HIV model (contResults: HIV model (cont’’d)d)
• Caribbean: Four countries [86% of HIV infections]Jamaica 494 (36%)Trinidad 277 (20%)Guyana 261 (19%)Haiti 147 (11%)
• Africa: Five countries [66% of HIV infections]Ethiopia 366 (29%)Uganda 131 (10%)Somalia 127 (10%)South Africa 114 ( 9%)Kenya 88 ( 7%)
Laboratories Branch, MOHLTC, IMC – 2001
Results: HIV model (contResults: HIV model (cont’’d) d)
• Substantial HIV transmission in Canada, representing 22-59% of HIV infections
• Male: female ratios indicate importance of MSM, especially from Caribbean
• Marked increase in recent years • Annual increase of about 270 HIV infections, or about
12%, in latest year
Laboratories Branch, MOHLTC, IMC – 2001
Modeled HIV prevalence among persons born in Modeled HIV prevalence among persons born in subsub--Saharan Africa or Caribbean, Ontario, 1981Saharan Africa or Caribbean, Ontario, 1981--20022002
Modeled number of imported and newly Modeled number of imported and newly acquired HIV infections among persons acquired HIV infections among persons born in HIVborn in HIV--endemic countries, 1992endemic countries, 1992--20022002
Modeled and projected number of HIV infections Modeled and projected number of HIV infections among persons born in HIVamong persons born in HIV--endemic countries, endemic countries, Ontario, 1992Ontario, 1992--20122012