Empirical validation of the UNAIDS Spectrum model for subnational HIV estimates: case-study of children and adults in Manicaland, Zimbabwe

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Title: Empirical validation of the UNAIDS Spectrum model for subnational HIV estimates: case-study of children and adults in Manicaland, Zimbabwe
Author(s): Silhol, R
Gregson, S
Nyamukapa, C
Mhangara, M
Dzangare, J
Gonese, E
Eaton, JW
Case, KK
Mahy, M
Stover, J
Mugurungi, O
Item Type: Journal Article
Abstract: Background: More cost-effective HIV control may be achieved by targeting geographical areas with high infection rates. The AIDS Impact model of Spectrum – used routinely to produce national HIV estimates – could provide the required subnational estimates but is rarely validated with empirical data, even at a national level. Design: The validity of the Spectrum model estimates were compared to empirical estimates. Methods: Antenatal surveillance and population survey data from a population HIV cohort study in Manicaland, east Zimbabwe, were input into Spectrum 5.441 to create a simulation representative of the cohort population. Model and empirical estimates were compared for key demographic and epidemiological outcomes. Alternative scenarios for data availability were examined and sensitivity analyses were conducted for model assumptions considered important for subnational estimates. Results: Spectrum estimates generally agreed with observed data but HIV incidence estimates were higher than empirical estimates while estimates of early age all-cause adult mortality were lower. Child HIV prevalence estimates matched well with the survey prevalence among children. Estimated paternal orphanhood was lower than empirical estimates. Including observations from earlier in the epidemic did not improve the HIV incidence model fit. Migration had little effect on observed discrepancies - possibly because the model ignores differences in HIV prevalence between migrants and residents. Conclusions: The Spectrum model, using subnational surveillance and population data, provided reasonable subnational estimates although some discrepancies were noted. Differences in HIV prevalence between migrants and residents may need to be captured in the model if applied to subnational epidemics.
Publication Date: 1-Apr-2017
Date of Acceptance: 16-Jan-2017
URI: http://hdl.handle.net/10044/1/44063
DOI: https://dx.doi.org/10.1097/QAD.0000000000001418
ISSN: 0269-9370
Publisher: Lippincott, Williams & Wilkins
Start Page: S41
End Page: S50
Journal / Book Title: AIDS
Volume: 31
Issue: Suppl. 1
Copyright Statement: © 2017 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: Wellcome Trust
Wellcome Trust
UNAIDS
UNAIDS
National Institutes of Health
Funder's Grant Number: 069516/Z/02/Z
084401/Z/07/Z
200140529
PO201153562
1R03AI125001-01A1
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
HIV estimates
HIV incidence rate
Mathematical model validation
models/projections
paediatric estimates
Spectrum model
Zimbabwe
ANTIRETROVIRAL THERAPY ERA
EASTERN ZIMBABWE
RURAL ZIMBABWE
GLOBAL BURDEN
PREVALENCE
EPIDEMIC
SURVEILLANCE
POPULATION
INFECTION
MORTALITY
Virology
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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