Mahiane, Severin GuySeverin GuyMahianeEaton, JeffreyJeffreyEatonGlaubius, RobertRobertGlaubiusCase, Kelsey KKelsey KCaseSabin, KeithKeithSabinMarsh, KimberlyKimberlyMarsh2021-07-292021-09Journal of the International AIDS Society, 2021, 24 (S5), pp.1-91758-2652http://hdl.handle.net/10044/1/90662Introduction: The Case Surveillance and Vital Registration (CSAVR) model within Spectrum estimates HIV incidence trends from surveillance data on numbers of new HIV diagnoses and HIV-related deaths. This article describes developments of the CSAVR tool to more flexibly model diagnosis rates over time, estimate incidence patterns by sex and age group, and by key population group. Methods: We modelled HIV diagnosis rate trends as a mixture of three factors, including temporal and opportunistic infection components. The tool was expanded to estimate incidence rate ratios by sex and age for countries with disaggregated reporting of new HIV diagnoses and AIDS deaths, and to account for information on key populations such as men who have sex with men (MSM), males who inject drugs (MWID), female sex workers (FSW) and females who inject drugs (FWID). We used a Bayesian framework to calibrate the tool in 71 high-income or low HIV burden countries. Results: Across countries, an estimated median 89% (interquartile range [IQR] 78%-96%) of HIV-positive adults knew their status in 2019. Mean CD4 counts at diagnosis were stable over time, with a median of 456 cells/μl (IQR: 391-508) across countries in 2019. In European countries reporting new HIV diagnoses among key populations median estimated proportions of males that are MSM and MWID was 1.3% (IQR: 0.9%- 2.0%) and 0.56% (IQR: 0.51%- 0.64%), respectively. The median estimated proportions of females that are FSW and FWID were 0.36% (IQR: 0.27%-0.45%) and 0.14 (IQR: 0.13%- 0.15%), respectively. HIV incidence per 100 person-year increased among MSM with median estimates reaching 0.43 (IQR: 0.29-1.73) in 2019, but remained stable in MWID, FSW and FWID, at around 0.12 (IQR: 0.04-1.9), 0.09 (IQR: 0.06-0.69) and 0.13% (IQR: 0.08%-0.91%) in 2019, respectively. Knowledge of HIV status among HIV-positive adults gradually increased since the early 1990s to exceed 75% in more than 75% of countries in 2019 among each key population. Conclusions: CSAVR offers an approach to using routine surveillance and vital registration data to estimate and project trends in both HIV incidence and knowledge of HIV status.© 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.HIV case-based surveillanceHIV incidenceHIV-related mortalitykey populationknowledge of statusstatistical models1103 Clinical Sciences1117 Public Health and Health Services1199 Other Medical and Health SciencesJournal Articlehttps://www.dx.doi.org/10.1002/jia2.25777https://onlinelibrary.wiley.com/doi/10.1002/jia2.257775776-ICS-DHHS-6664OPP1190661MR/R015600/1