spectrum 2007 overview and new changes
DESCRIPTION
Spectrum 2007 Overview and New Changes. UNAIDS Reference Group on Estimates, Model and Projections 2007. 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 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/1.jpg)
Spectrum 2007Overview and New Changes
UNAIDS Reference Group on Estimates, Model and Projections
2007
![Page 2: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/2.jpg)
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 and vulnerable children
![Page 3: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/3.jpg)
New Features
1. New treatment options• Adults: 1st and 2nd line ART• Children: ART and cotrimoxazole
2. Updated progression periods• New infection to need for treatment• Need for treatment to AIDS death w/wo treatment
3. Expanded PMTCT options4. Calibrate to multiple national surveys5. Uncertainty analysis
![Page 4: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/4.jpg)
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
![Page 5: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/5.jpg)
Creating a new projection
![Page 6: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/6.jpg)
Population Projection
![Page 7: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/7.jpg)
Population Projection
![Page 8: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/8.jpg)
Population Projection
The first year of the projection must be before the start of the AIDS epidemic, usually 1980
![Page 9: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/9.jpg)
Population Projection
The last year of the projection can be anything up to 50 years, but it is best to match the prevalence estimate (2012 for EPP, 2007 for the Workbook)
![Page 10: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/10.jpg)
Population Projection
![Page 11: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/11.jpg)
Population Projection
![Page 12: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/12.jpg)
Population Projection
Creates a projection using the UN Population Division’s World Population Prospects
![Page 13: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/13.jpg)
Entering data
![Page 14: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/14.jpg)
Selecting inputs to edit
![Page 15: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/15.jpg)
Adult HIV Prevalence
![Page 16: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/16.jpg)
Adult HIV Prevalence
![Page 17: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/17.jpg)
Documenting sources
![Page 18: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/18.jpg)
Effect of HIV on fertility
![Page 19: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/19.jpg)
Effect of HIV on fertility
15-19: 50% increase
20-49: 30% decrease
TFR of HIV- adjusted to leave population TFR unchanged
![Page 20: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/20.jpg)
Age and Sex Ratio of HIV Prevalence
![Page 21: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/21.jpg)
Ratio of prevalence at each 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 +
![Page 22: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/22.jpg)
Ratio of prevalence at each 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
![Page 23: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/23.jpg)
Age and Sex Ratio of HIV Prevalence
![Page 24: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/24.jpg)
Sex ratio of HIV prevalence
![Page 25: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/25.jpg)
Sex ratio of HIV prevalence
![Page 26: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/26.jpg)
Ratio of Female to Male HIV Prevalence
0.0
0.5
1.0
1.5
2.0
2.5
0 5 10 15 20 25
Years Since the Start of the Epidemic
Cameroon DHS
Zambia DHS
Kenya DHSGhana DHS
Burkina Faso DHS
Kapiri Mposhi 98
Masaka 89-97Rwanda 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
![Page 27: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/27.jpg)
Progression from HIV Infection to AIDS Death (Adults)
New HIV Infection
Need for Treatment
First Line ART
AIDS Death
Second Line ART
Need for 2nd Line
![Page 28: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/28.jpg)
Net survival adjusted to age 25-29
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 1 2 3 4 5 6 7 8 9 1 1
Kisesa
Masaka
Rakai
SA miners
Thai military
0 1
Source: Zaba and Todd, Alpha network
![Page 29: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/29.jpg)
Time from AIDS or CD4<200 to death in the absence of HAART
Time measured from
Published studies from resource-poor settings (median, range)
Estimates from the Swiss HIV cohort study (median, 95% CI)
AIDS
CD4 count <200 (median 100)
150< CD4< 250 (median 200)
11 (7 – 19)
11 (7 – 38)
35 (estimated)
17.6 (15.9 – 19)
24.0 (22.0 – 29.0)
77.0 (52.0 – 92.0)
Source: Zwahlen and Egger
![Page 30: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/30.jpg)
Time from CD4 < 350 to death, and from CD4 < 350 combined with WHO stage III or IV to death in resource limited settings
Time measured from
Natural history of untreated patients
Bayesian synthesis analysis
200 < CD4 < 350
WHO stage III or IV and CD4 < 350
4 – 5 years 5.4 (1.9 – 15.7 years)
2.7 (0.76 – 9.6 years)
Source: Zwahlen and Egger
![Page 31: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/31.jpg)
Incidence (%) of Death After Starting ART
3 months 6 months 12 months 24 monthsBrainstein 2006 5.1 [3.3 – 7.7] 5.1 [3.3 – 7.9] 2.7 [1.9 – 4.0]Etard 2006 12.5 [9.4 – 16.7] 6.6 [4.3 – 10.0]Jerene 2006 37.3 [N M]Lawn 2006 19.1 [14.4-25.2] 2.9 [1.8-4.8] 1.3 [0.4-3.9]Lawn 2005 19.4 [13.0-28.9] 6.2 [2.8-13.9] 2.9 [1.1-7.8]
Source: Dabis et al, ISPED
![Page 32: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/32.jpg)
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% SY3 years
![Page 33: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/33.jpg)
Progression from HIV Infection to AIDS Death (Children)
New HIV Infection
Need for Treatment
First Line ARTAIDS Death
Age-dependent
>5 = 3 years<1, 0.80
>1, 0.9 first year, else 0.95
Marston and Newell, median = 2 years
![Page 34: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/34.jpg)
![Page 35: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/35.jpg)
![Page 36: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/36.jpg)
Adult Male Progression without Treatment
0
20
40
60
80
100
0 2 4 6 8 10 12 14 16 18 20
Years Since Infection
Need TreatmentDead
![Page 37: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/37.jpg)
Adult Male Progression with Treatment
0
10
20
30
40
50
60
0 2 4 6 8 10 12 14 16 18 20
Years Since Infection
On FLOn SLDead
![Page 38: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/38.jpg)
The Need for ART will change from 2005 estimate!
0
50,000
100,000
150,000
200,000
250,000
300,000
1980 1985 1990 1995 2000
2007
2005
![Page 39: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/39.jpg)
![Page 40: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/40.jpg)
![Page 41: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/41.jpg)
![Page 42: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/42.jpg)
Projections of Adult ART Coverage
0102030405060708090
100
2000 2002 2004 2006 2008 2010 2012
Linear Trend Unmet Need % Target Unmet Need Trend
![Page 43: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/43.jpg)
![Page 44: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/44.jpg)
![Page 45: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/45.jpg)
![Page 46: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/46.jpg)
Orphans
% women 15-19 never married: 38%-94% (71%)
% married women in monogamous union: 45%-96% (71%)
![Page 47: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/47.jpg)
Spectrum outputs
![Page 48: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/48.jpg)
Various displays are available
![Page 49: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/49.jpg)
Comparing effects
• Display up to four projections at one time
• Open same projection twice and rename to create comparison scenarios
![Page 50: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/50.jpg)
Estimates of Need
Adult ART •Adults progressed to need for treatment•Simulates WHO guidelines
Child ART Children progressed to moderate-to-severe disease
Cotrimoxazole •Early detection–All HIV+ children
•No early detection–Children born to HIV+ mothers until 18 months–All HIV+ children over 18 months
PMTCT All births to HIV+ women
![Page 51: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/51.jpg)
Plausibility Bounds
![Page 52: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/52.jpg)
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
![Page 53: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/53.jpg)
![Page 54: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/54.jpg)
![Page 55: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/55.jpg)
![Page 56: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/56.jpg)
![Page 57: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/57.jpg)
![Page 58: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/58.jpg)
Summary Table – Plausibility Bounds
![Page 59: Spectrum 2007 Overview and New Changes](https://reader035.vdocuments.site/reader035/viewer/2022062500/56815a17550346895dc76041/html5/thumbnails/59.jpg)
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