| Title: |
Naomi: a new modelling tool for estimating HIV epidemic indicators at the district level in Sub-Saharan Africa |
| Authors: |
Eaton, J; Dwyer-Lindgren, L; Gutreuter, S; O'Driscoll, M; Stevens, O; Bajaj, S; Ashton, R; Hill, A; Russell, E; Esra, R; Dolan, N; Anifowoshe, Y; Woodbridge, M; Fellows, I; Glaubius, R; Haeuser, E; Okonek, T; Stover, J; Thomas, M; Wakefield, J; Wolock, T; Berry, J; Sabala, T; Heard, N; Delgado, S; Jahn, A; Kalua, T; Chimpandule, T; Auld, A; Kim, E; Payne, D; Johnson, LF; Fitzjohn, R; Wanyeki, I; Mahy, M; Shiraishi, RW |
| Contributors: |
National Institutes of Health; UNAIDS; Bill & Melinda Gates Foundation; Medical Research Council (MRC) |
| Source: |
13 ; 1 |
| Publisher Information: |
International AIDS Society |
| Publication Year: |
2021 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Bayesian statistics; HIV estimates; joint modelling; routine data; small-area estimation; ANTIRETROVIRAL THERAPY; 1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences |
| Description: |
Introduction: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. Methods: Small-area regressions for HIV prevalence, ART coverage, and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016 to 2018. Results: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi’s districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV were among ages 35-39 for both women and men, while the most untreated PLHIV were among ages 25-29 for women and 30-34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe City, an estimated 71% (95% CI 61–79%) resided in Lilongwe City, 20% (14–27%) in Lilongwe district outside the metropolis, and 9% (6–12%) in neighbouring Dowa district. Thirty-eight percent (26–50%) of Lilongwe Rural residents and 39% (27–50%) of Dowa residents received treatment at facilities in Lilongwe City. Conclusions: The Naomi model ... |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
Journal of the International AIDS Society; http://hdl.handle.net/10044/1/90881; 2017/778519; MR/R015600/1; 2019/974072 |
| DOI: |
10.1002/jia2.25788 |
| Availability: |
http://hdl.handle.net/10044/1/90881; https://doi.org/10.1002/jia2.25788 |
| Rights: |
© 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. ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.A54DCF21 |
| Database: |
BASE |