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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.

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Title: The estimation and projection package age-sex model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.
Authors: Eaton, JW
Brown, T
Puckett, R
Glaubius, R
Mutai, K
Bao, L
Salomon, JA
Stover, J
Mahy, M
Hallett, TB
Item Type: Journal Article
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.
Issue Date: 15-Dec-2019
Date of Acceptance: 31-Oct-2019
URI: http://hdl.handle.net/10044/1/75693
DOI: 10.1097/QAD.0000000000002437
ISSN: 0269-9370
Publisher: Lippincott, Williams & Wilkins
Start Page: S235
End Page: S244
Journal / Book Title: AIDS
Volume: 33
Copyright Statement: © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: National Institutes of Health
National Institutes of Health
Medical Research Council (MRC)
Funder's Grant Number: 1R03AI125001-01A1
Keywords: Virology
06 Biological Sciences
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Publication Status: Published
Conference Place: England
Open Access location: https://journals.lww.com/aidsonline/Fulltext/2019/12153/The_Estimation_and_Projection_Package_Age_Sex.5.aspx
Online Publication Date: 2019-12-15
Appears in Collections:School of Public Health