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Spectrum 2007 Overview and New Changes UNAIDS Reference Group on Estimates, Modelling and Projections 2007 Purpose Determine the consequences of the prevalence estimates made with EPP or Workbook New infections, HIV+ population,

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Spectrum 2007 Overview and New Changes

UNAIDS Reference Group on Estimates, Modelling and Projections 2007

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Purpose

Determine the consequences of the

prevalence estimates made with EPP or Workbook

– New infections, HIV+ population, AIDS deaths – Need for treatment and effects of treatment – Orphans

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New Features

1. New treatment options

Adults: 1st and 2nd line ART
Children: ART and co-trimoxazole

2. Updated progression periods

New infection to need for treatment
Need for treatment to AIDS death w/wo treatment

3. Expanded PMTCT options 4. Calibrate to multiple national surveys 5. Uncertainty analysis

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Inputs required

Country data

Demographic data
Adult prevalence
MTCT program

description

PMTCT coverage
Adult ART coverage
Child treatment

coverage Epidemic patterns

Effect of HIV on fertility
Progression from infection to

need for treatment and to AIDS death

Sex ratio of prevalence
Age distribution of infection
Mother-to-child transmission

rates by regimen and feeding options

Effect of child treatment

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Creating a new projection

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Population Projection

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Population Projection

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Population Projection

T he fir st ye a r

f the pr
je c tion must be

be for e the sta r t of the AIDS e pide mic , usua lly 1980

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Population Projection

T he la st ye a r

f the pr
je c tion c a n be

a nything up to 50 ye a rs, but it is be st to ma tc h the pre va le nc e e stima te (2012 for E PP, 2007 for the Workbook)

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Population Projection

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Population Projection

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Population Projection

Cr e a te s a pr

je c tion using the UN

Popula tion Division’s Wor

ld Population Pr

spe c ts

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Entering data

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Selecting inputs to edit

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Adult HIV Prevalence

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Adult HIV Prevalence

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Documenting sources

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Effect of HIV on fertility

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Effect of HIV on fertility

15- 19: 50% inc re a se 20- 49: 30% de c re a se T F R of HIV- a djuste d to le a ve popula tion T F R unc ha ng e d

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Age and Sex Ratio of HIV Prevalence

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Ratio of prevalence at each age group to prevalence at 25-29 : Females

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1980 1985 1990 1995 2000 2005 2010 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 +

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Ratio of prevalence at each age group to prevalence at 25-29 : Males

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1980 1985 1990 1995 2000 2005 2010 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59

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Age and Sex Ratio of HIV Prevalence

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Sex ratio of HIV prevalence

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Sex ratio of HIV prevalence

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Ratio of Female to Male HIV Prevalence

0.0 0.5 1.0 1.5 2.0 2.5 5 10 15 20 25 Years Since the Start of the Epidemic

Cameroon DHS Zambia DHS Kenya DHS Ghana DHS Burkina Faso DHS Kapiri Mposhi 98 Masaka 89-97 Rwanda 86 Uganda 88 Mali DHS DR DHS Uganda 2004-05 Rwanda DHS Senegal DHS Guinea DHS Tanzania DHS Lesotho DHS South Africa HSRC Cote d'Ivoire DHS Malawi 2004 Ethiopia DHS Zim

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Progression from HIV Infection to AIDS Death (Adults)

New HIV Infection Need for Treatment First Line ART AIDS Death Second Line ART

Normal M 7.5yrs/F 8.5yrs, fast 6.1/6.9 3 years 15%/5%

Need for 2nd Line

15% FY / 5% SY

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Progression from HIV Infection to AIDS Death (Children)

New HIV Infection Need for Treatment First Line ART AIDS Death

Age-dependent Age-dependent

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Adult Male Progression without Treatment

20 40 60 80 100 2 4 6 8 10 12 14 16 18 20 Years Since I nfection Need Treatment Dead

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Projections of Adult ART Coverage

10 20 30 40 50 60 70 80 90 100

2000 2002 2004 2006 2008 2010 2012

Linear Trend Unmet Need % Target Unmet Need Trend

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Orphans

% women 15-19 never married: 38%-94% (71%) % married women in monogamous union: 45%-96% (71%)

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Spectrum outputs

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Various displays are available

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Comparing effects

Display up to four

projections at one time

Open same

projection twice and rename to create comparison scenarios

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Plausibility Bounds

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Plausibility Bounds

Uncertainty around prevalence curve

– EPP: read sampled curve from EPP .spu file – Workbook: generate 1000 logistic curve fits by varying annual estimates according to data quality

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Logistic Curve Fits to Annual Estimates

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% 2.0% 1980 1985 1990 1995 2000 2005 2010

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Logistic Curve Fits to Annual Estimates with 95% Plausibility Bounds

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% 2.0% 1980 1985 1990 1995 2000 2005 2010

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If you use the Workbook you need to generate prevalence curves

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After generating prevalence curves from Workbook estimates process the uncertainty analysis

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Exercise

Create a new demographic projection using

EasyProj

Read prevalence estimate from EPP or

Projections Workbook

Select appropriate patterns for Progression

and Age/Sex Ratios

Add data on coverage of PMTCT, ART and

child treatment programs

Review key indicators
Do uncertainty analysis