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Esra R, Mmelesi M, Ketlogetswe AT, Wolock TM, Howes A, Nong T, Matlhaga MT, Ratladi S, Ramaabya D, Imai-Eaton JW. Improved Indicators for Subnational Unmet Antiretroviral Therapy Need in the Health System: Updates to the Naomi Model in 2023. J Acquir Immune Defic Syndr 2024; 95:e24-e33. [PMID: 38180736 PMCID: PMC10769176 DOI: 10.1097/qai.0000000000003324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Quantifying subnational need for antiretroviral therapy (ART) for HIV is challenging because people living with HIV (PLHIV) access health facilities in areas that may differ from their residence. We defined and demonstrated new indicators for PLHIV treatment needed to guide health system target setting and resource allocation. SETTING Botswana. METHODS We extended Naomi, a Bayesian small-area model for estimating district-level HIV indicators from national household survey and HIV service delivery data. We used model outputs for ART seeking probabilities in neighboring districts to define the "PLHIV (attending)" indicator representing the estimated number of PLHIV who would seek treatment at health facilities in a district, and "Untreated PLHIV attending" representing gaps in ART service provision. Botswana 2021 district HIV estimates were used to demonstrate new outputs and assess the sensitivity to uncertainty in district population sizes. RESULTS Across districts of Botswana, estimated adult ART coverage in December 2021 ranged 90%-96%. In the capital city Gaborone, there were 50,400 resident PLHIV and 64,200 receiving ART, of whom 24% (95% CI: 20 to 32) were estimated to reside in neighboring districts. Applying ART attendance probabilities gave a "PLHIV attending" denominator of 68,300 and unmet treatment need of 4100 adults (95% CI: 3000 to 5500) for Gaborone health facilities. The facility-based "PLHIV attending" denominator was less-sensitive to fluctuations in district population size assumptions. CONCLUSIONS New indicators provided more consistent targets for HIV service provision, but are limited by ART data quality. This challenge will increase as treatment coverage reaches high levels and treatment gaps are smaller.
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Affiliation(s)
- Rachel Esra
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Timothy M. Wolock
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Adam Howes
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Tlotlo Nong
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Siphiwe Ratladi
- National AIDS and Health Promotion Agency, Gaborone, Botswana; and
| | - Dinah Ramaabya
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Brown T, Peerapatanapokin W, Siripong N, Puckett R. The AIDS Epidemic Model 2023 for Estimating HIV Trends and Transmission Dynamics in Asian Epidemic Settings. J Acquir Immune Defic Syndr 2024; 95:e13-e23. [PMID: 38180846 PMCID: PMC10769178 DOI: 10.1097/qai.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Thirteen Asian countries use the AIDS Epidemic Model (AEM) as their HIV model of choice. This article describes AEM, its inputs, and its application to national modeling. SETTING AEM is an incidence tool used by Spectrum for the Joint United Nations Programme on HIV/AIDS global estimates process. METHODS AEM simulates transmission of HIV among key populations (KPs) using measured trends in risk behaviors. The inputs, structure and calculations, interface, and outputs of AEM are described. The AEM process includes (1) collating and synthesizing data on KP risk behaviors, epidemiology, and size to produce model input trends; (2) calibrating the model to observed HIV prevalence; (3) extracting outputs by KP to describe epidemic dynamics and assist in improving responses; and (4) importing AEM incidence into Spectrum for global estimates. Recent changes to better align AEM mortality with Spectrum and add preexposure prophylaxis are described. RESULTS The application of AEM in Thailand is presented, describing the outputs and uses in-country. AEM replicated observed epidemiological trends when given observed behavioral inputs. The strengths and limitations of AEM are presented and used to inform thoughts on future directions for global models. CONCLUSIONS AEM captures regional HIV epidemiology well and continues to evolve to meet country and global process needs. The addition of time-varying mortality and progression parameters has improved the alignment of the key population compartmental model of AEM with the age-sex-structured national model of Spectrum. Many of the features of AEM, including tracking the sources of infections over time, should be incorporated in future global efforts to build more generalizable models to guide policy and programs.
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Affiliation(s)
- Tim Brown
- Research Program, East-West Center, Honolulu, HI; and
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Bulterys MA, Njuguna I, Mahy M, Gulaid LA, Powis KM, Wedderburn CJ, John-Stewart G. Neurodevelopment among children exposed to HIV and uninfected in sub-Saharan Africa. J Int AIDS Soc 2023; 26 Suppl 4:e26159. [PMID: 37909232 PMCID: PMC10618877 DOI: 10.1002/jia2.26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The population of 16 million children exposed to HIV and uninfected (CHEU) under 15 years of age continues to expand rapidly, and the estimated prevalence of CHEU exceeds 20% in several countries in sub-Saharan Africa with high HIV prevalence. Some evidence suggests that CHEU experience suboptimal neurodevelopmental outcomes compared to children born to women without HIV. In this commentary, we discuss the latest research on biologic and socio-behavioural factors associated with neurodevelopmental outcomes among CHEU. DISCUSSION Some but not all studies have noted that CHEU are at risk of poorer neurodevelopment across multiple cognitive domains, most notably in language and motor skills, in diverse settings, ages and using varied assessment tools. Foetal HIV exposure can adversely influence infant immune function, structural brain integrity and growth trajectories. Foetal exposure to antiretrovirals may also influence outcomes. Moreover, general, non-CHEU-specific risk factors for poor neurodevelopment, such as preterm birth, food insecurity, growth faltering and household violence, are amplified among CHEU; addressing these factors will require multi-factorial solutions. There is a need for rigorous harmonised approaches to identify children at the highest risk of delay. In high-burden HIV settings, existing maternal child health programmes serving the general population could adopt structured early child development programmes that educate healthcare workers on CHEU-specific risk factors and train them to conduct rapid neurodevelopmental screening tests. Community-based interventions targeting parent knowledge of optimal caregiving practices have shown to be successful in improving neurodevelopmental outcomes in children and should be adapted for CHEU. CONCLUSIONS CHEU in sub-Saharan Africa have biologic and socio-behavioural factors that may influence their neurodevelopment, brain maturation, immune system and overall health and wellbeing. Multidisciplinary research is needed to disentangle complex interactions between contributing factors. Common environmental and social risk factors for suboptimal neurodevelopment in the general population are disproportionately magnified within the CHEU population, and it is, therefore, important to draw on existing knowledge when considering the socio-behavioural pathways through which HIV exposure could impact CHEU neurodevelopment. Approaches to identify children at greatest risk for poor outcomes and multisectoral interventions are needed to ensure optimal outcomes for CHEU in sub-Saharan Africa.
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Affiliation(s)
- Michelle A Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Laurie A Gulaid
- UNICEF, eastern and southern Africa Regional Office, Nairobi, Kenya
| | - Katheen M Powis
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine J Wedderburn
- Department of Pediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
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Birri Makota RB, Musenge E. Estimating HIV incidence over a decade in Zimbabwe: A comparison of the catalytic and Farrington models. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001717. [PMID: 37708116 PMCID: PMC10501625 DOI: 10.1371/journal.pgph.0001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
Over the years, numerous modelling studies have been proposed to estimate HIV incidence. As a result, this study aimed to evaluate two alternative methods for predicting HIV incidence in Zimbabwe between 2005 and 2015. We estimated HIV incidence from seroprevalence data using the catalytic and Farrington-2-parameter models. Data were obtained from 2005-06, 2010-11, and 2015 Zimbabwe Demographic Health Survey (ZDHS). These models were validated at the micro and macro-level using community-based cohort incidence and empirical estimates from UNAIDS EPP/SPECTRUM, respectively. The HIV incidence for the catalytic model was 0.32% (CI: 0.28%, 0.36%), 0.36% (CI: 0.33%, 0.39%), and 0.28% (CI: 0.26%, 0.30%), for the years 2005-06, 2010-11, and 2015, respectively. The HIV incidence for the Farrington model was 0.21% (CI: 0.16%, 0.26%), 0.22% (CI: 0.20%, 0.25%), and 0.19% (CI: 0.16%, 0.22%), for the years 2005-06, 2010-11, and 2015, respectively. According to these findings, the catalytic model estimated a higher HIV incidence rate than the Farrington model. Compared to cohort estimates, the estimates were within the observed 95% confidence interval, with 88% and 75% agreement for the catalytic and Farrington models, respectively. The limits of agreement observed in the Bland-Altman plot were narrow for all plots, indicating that our model estimates were comparable to cohort estimates. Compared to UNAIDS estimates, the catalytic model predicted a progressive increase in HIV incidence for males throughout all survey years. Without a doubt, HIV incidence declined with each subsequent survey year for all models. To improve programmatic and policy decisions in the national HIV response, we recommend the triangulation of multiple methods for incidence estimation and interpretation of results. Multiple estimating approaches should be considered to reduce uncertainty in the estimations from various models.
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Affiliation(s)
- Rutendo Beauty Birri Makota
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yeshaneh A, Abebe H, Tafese FE, Workineh A. Knowledge, attitude, and practice towards prevention of mother-to-child transmission of HIV among antenatal care attendees in Ethiopia, 2020. PLoS One 2023; 18:e0277178. [PMID: 36827389 PMCID: PMC9956789 DOI: 10.1371/journal.pone.0277178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/21/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND In 2020, globally approximately 37.6 million people living with HIV and 700,000 children are born infected from their parents. Every day there are nearly 1800 new Human Immune Virus (HIV) infections in children, more than 90% occurring in the developing world. Approximately 90% of these infections are associated with mother-to-child transmission (MTCT). In 2019, Ethiopia had over 100,000 pregnancies in HIV-positive women and over 12,000 HIV-positive. Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant mothers toward the prevention of mother-to-child transmission of HIV.ss. METHODS An institutional-based cross-sectional study was conducted among 216 antenatal care (ANC) attendees in Gurage zone hospitals from June to July 2020. Data were collected using a structured and pre-tested questionnaire through face-to-face interviews. A Systematic random sampling technique with proportional allocation to size was used to select study subjects. Data entry and analysis were performed using Epi Data version 4.1 and SPSS version 25 respectively. RESULTS The level of good knowledge, attitude, and practice towards Prevention of mother to child transmission (PMTCT) of HIV among antenatal care attendees was found to be 72.2%, 79%, and 62% respectively. This study has also shown that at the time of transmission of the virus from the infected mother to her child, 38.9% of the respondents responded that it could be through breastfeeding, 38.9% during pregnancy, 16.5% during labor and 5.7% did not know respectively. All the respondents have been tested and 0.92% was positive. Nearly half, 99 (45.8%) of the respondents had tested for HIV/AIDS with their partner/husband during their ANC follow-up. CONCLUSION In this study, the level of good knowledge, attitude, and practice towards PMTCT of HIV among antenatal care attendees were low. This finding also suggests that healthcare providers should consider the potential risk of mother-to-child transmission of HIV while providing clinical health assessments during antenatal care visits. Thus, improvement of counseling sessions and knowledge of PMTCT for pregnant women attending antenatal care is needed to increase their acceptance and use of PMTCT for HIV services.
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Affiliation(s)
- Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Haimanot Abebe
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | | | - Alemu Workineh
- Saving Little Lives (SLL) Project, Hawassa University, Hawassa, Ethiopia
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Mahy MI, Sabin KM, Feizzadeh A, Wanyeki I. Progress towards 2020 global HIV impact and treatment targets. J Int AIDS Soc 2021; 24 Suppl 5:e25779. [PMID: 34546655 PMCID: PMC8454678 DOI: 10.1002/jia2.25779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Over the past 20 years, the response to the HIV epidemic has achieved remarkable results. These results have often been motivated by targets adopted by countries through United Nations (UN) Political Declarations on HIV. The 2016 political declaration included two impact targets, to achieve a 75% decline in new HIV infections and AIDS-related deaths between 2010 and 2020, and to reach the 90-90-90 testing and treatment targets by 2020. Our objective is to summarize progress towards these targets using robust and comparable HIV estimates released by UNAIDS in July 2021. In addition, we comment on the importance of targets and the modelled estimates required to quantify those targets. DISCUSSION The UNAIDS estimates indicate that at the global and regional levels, the 2020 targets were missed: new infections declined by 31% and AIDS-related deaths declined by 47% between 2010 and 2020, compared to a target of 75% decline for both indicators. Similarly, no region achieved the 90-90-90 testing and treatment targets. Some countries, in diverse settings, achieved these targets showing that the targets were not overly ambitious if the right funding, policies and evidence-informed interventions at the right scale were in place. The 2021 UN Political Declaration on HIV, adopted on 8 June 2021, has set out a new set of ambitious but achievable targets for 2025. The 2025 targets and the required actions to reach those targets are described in the Global AIDS Strategy 2021-2026, which provides a framework to reprioritize HIV responses by reducing inequalities and building on the achievements of multiple Sustainable Development Goals. The Strategy encourages countries to monitor progress against targets for different geographic areas and populations to maximize equitable services and ensure accountability and also to understand why targets are being missed. CONCLUSIONS The UNAIDS epidemiological estimates provide information that promote accountability and estimate progress towards global targets at the national level. Additional strategic information and analyses are required to identify the populations that are furthest from the targets and the programmes and policies that are keeping countries from meeting their targets.
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Affiliation(s)
- Mary I. Mahy
- Strategic Information DepartmentUNAIDSGenevaSwitzerland
| | | | - Ali Feizzadeh
- Strategic Information DepartmentUNAIDSGenevaSwitzerland
| | - Ian Wanyeki
- Strategic Information DepartmentUNAIDSGenevaSwitzerland
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Pisani E, Hasnida A, Rahmi M, Kok MO, Harsono S, Anggriani Y. Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance. JMIR Public Health Surveill 2021; 7:e29309. [PMID: 34181563 PMCID: PMC8406122 DOI: 10.2196/29309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/09/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
The World Health Organization and others warn that substandard and falsified medicines harm health and waste money, especially in low- and middle-income countries. However, no country has measured the market-wide extent of the problem, and no standardized methods exist to estimate the prevalence of either substandard or falsified medicines. This is, in part, because the task seems overwhelming; medicine markets are huge and diverse, and testing medicines is expensive. Many countries do operate some form of postmarket surveillance of medicine, but their methods and goals differ. There is currently no clear guidance on which surveillance method is most appropriate to meet specific public health goals. In this viewpoint, we aimed to discuss the utility of both case finding and risk-based sentinel surveillance for substandard and falsified medicines, linking each to specific public health goals. We posit that choosing the system most appropriate to the goal, as well as implementing it with a clear understanding of the factors driving the production and sale of substandard and falsified medicines, will allow for surveillance resources to be concentrated most efficiently. We adapted principles used for disease outbreak responses to suggest a case-finding system that uses secondary data to flag poor-quality medicines, proposing risk-based indicators that differ for substandard and falsified medicines. This system potentially offers a cost-effective way of identifying “cases” for market withdrawal, enhanced oversight, or another immediate response. We further proposed a risk-based sentinel surveillance system that concentrates resources on measuring the prevalence of substandard and falsified medicines in the risk clusters where they are most likely to be found. The sentinel surveillance system provides base data for a transparent, spreadsheet-based model for estimating the national prevalence of substandard and falsified medicines. The methods we proposed are based on ongoing work in Indonesia, a large and diverse middle-income country currently aiming to achieve universal health coverage. Both the case finding and the sentinel surveillance system are designed to be adaptable to other resource-constrained settings.
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Affiliation(s)
- Elizabeth Pisani
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands.,School of Public Health, Imperial College, London, United Kingdom.,Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
| | - Amalia Hasnida
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Mawaddati Rahmi
- Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
| | - Maarten Olivier Kok
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Yusi Anggriani
- Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
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Priya Dharshini K, Fang H, Ramya Devi D, Yang JX, Luo RH, Zheng YT, Brzeziński M, Vedha Hari BN. pH-sensitive chitosan nanoparticles loaded with dolutegravir as milk and food admixture for paediatric anti-HIV therapy. Carbohydr Polym 2020; 256:117440. [PMID: 33483020 DOI: 10.1016/j.carbpol.2020.117440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
The present study aims to develop Chitosan-based polymeric nanoparticles of anti-HIV drug Dolutegravir, to aid appropriate dose adjustment and ease of oral administration as milk and food admixture for children. The isolated Chitosan from the crab shell species Portunus Sanguinolentus has been characterized for their physicochemical properties. Nanoparticles were developed with varying ratio of drug: Chitosan and assessed for particle size (140-548 nm), zeta potential (+26.1 mV) with a maximum of 75 % drug content. Nanoparticles exhibited improved stability and drug release in the 0.1 N HCl medium compared to pure drug. The MTT assay and the Syncytia inhibition assay in C8166 (T-lymphatic cell line) infected with HIVIIIB viral strain, which showed better therapeutic efficiency and lesser cytotoxicity compared to the pure drug. In consonance with the data obtained, the use of chitosan from a novel source for drug delivery carrier has opened exceptional prospects for delivering drugs efficiently to paediatrics.
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Affiliation(s)
- K Priya Dharshini
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Hao Fang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China
| | - D Ramya Devi
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Jin-Xuan Yang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming 650500, China
| | - Rong-Hua Luo
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
| | - Yong-Tang Zheng
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China.
| | - Marek Brzeziński
- Centre of Molecular and Macromolecular Studies in Łódź, Polish Academy of Sciences, Sienkiewicza 112, 90-363 Lodz, Poland
| | - B N Vedha Hari
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India.
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Gonese E, Musuka G, Ruangtragool L, Hakim A, Parekh B, Dobbs T, Duong YT, Patel H, Mhangara M, Mugurungi O, Mapingure M, Saito S, Herman-Roloff A, Gwanzura L, Tippett-Barr B, Kilmarx PH, Justman J. Comparison of HIV Incidence in the Zimbabwe Population-Based HIV Impact Assessment Survey (2015-2016) with Modeled Estimates: Progress Toward Epidemic Control. AIDS Res Hum Retroviruses 2020; 36:656-662. [PMID: 32498542 DOI: 10.1089/aid.2020.0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Between October 2015 and August 2016, Zimbabwe conducted the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) cross-sectional survey to determine progress toward epidemic control. Of 25,131 eligible adults aged 15-64 years, 20,577 (81.8%) consented to face-to-face questionnaire and biomarker testing in this nationally representative household survey. Home-based rapid HIV testing was performed using Determine, First Response, and STAT-PAK as the tiebreaker. HIV-positive tests were confirmed in a laboratory using Geenius HIV-1/2; viral load (VL) was measured using Roche TaqMan and BioMerieux NucliSENS. Recency of infection was tested using Sedia HIV-1 Limiting Antigen (LAg)-Avidity. Presence of antiretroviral (ARV) drugs was detected using high performance liquid chromatography/mass spectrometry (HPLC/MS). The recent infection testing algorithm included LAg-avidity enzyme immunoassay [normalized optical density (ODn ≤1.5), VL ≥1,000 copies/mL, and absence of ARV drugs]. Weighted annual HIV incidence was compared with United Nations Joint Programme on HIV/AIDS (UNAIDS) Spectrum models estimates. Overall, 26 of 2,901 HIV-seropositive individuals had a recent infection (men, 8; women, 18). Overall weighted annual incidence among persons aged 15-64 years was 0.42% [95% confidence interval (CI): 0.25-0.59] and was 0.44% (95% CI: 0.25-0.62) for those aged 15-49 years, similar to 2016 Spectrum model estimate (0.54%, 95% CI: 0.49-0.66) for this age group. Among persons aged 15-49 years, HIV prevalence was 13.35% (95% CI: 12.71-14.02), estimated HIV-positive individuals were 968,951 (95% CI: 911,473-1,026,430), of these, 41,911 (95% CI: 37,412-44,787) were annual-new infections, and this was similar to 2016 Spectrum estimates. The observed HIV incidence in ZIMPHIA 2015-2016 validated the 2016 Spectrum estimates and Zimbabwe's progress toward epidemic control.
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Affiliation(s)
- Elizabeth Gonese
- Division of Global AIDS and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | | | - Avi Hakim
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharat Parekh
- International Lab Branch, Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- International Lab Branch, Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yen T. Duong
- ICAP at Columbia University, New York, New York, USA
| | - Hetal Patel
- International Lab Branch, Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mutsa Mhangara
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Suzue Saito
- ICAP at Columbia University, New York, New York, USA
| | - Amy Herman-Roloff
- Division of Global AIDS and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Beth Tippett-Barr
- Division of Global AIDS and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Peter H. Kilmarx
- Division of Global AIDS and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
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Gona PN, Gona CM, Ballout S, Rao SR, Kimokoti R, Mapoma CC, Mokdad AH. Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990-2017. BMC Public Health 2020; 20:867. [PMID: 32503604 PMCID: PMC7274054 DOI: 10.1186/s12889-020-08988-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background The 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study. Methods The GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country. Results In 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7–35.2), followed by South Africa 28.5% (25.8–31.6), Lesotho, 25.1% (21.2–30.4), eSwatini 24.8% (21.3–28.6), and Mozambique 24.2% (20.6–29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6–1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion. Conclusions Great progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President’s Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.
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Affiliation(s)
- Philimon N Gona
- College of Nursing & Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Clara M Gona
- Department of Nursing, MGH Institute for Health Professions, Boston, MA, USA
| | - Suha Ballout
- College of Nursing & Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ruth Kimokoti
- Department of Nutrition, Simmons College, Boston, MA, USA
| | - Chabila C Mapoma
- Department of Population Studies, University of Zambia, Lusaka, Zambia
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Slogrove AL, Powis KM, Johnson LF, Stover J, Mahy M. Estimates of the global population of children who are HIV-exposed and uninfected, 2000-18: a modelling study. Lancet Glob Health 2020; 8:e67-e75. [PMID: 31791800 PMCID: PMC6981259 DOI: 10.1016/s2214-109x(19)30448-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Children who are HIV-exposed uninfected (HEU) have higher morbidity and mortality than children who are HIV-unexposed and uninfected despite safer breastfeeding and improved maternal health with maternal antiretroviral therapy. We present the first global estimates of the population of children who are HEU (aged 0-14 years) and the geographical and temporal trends in HIV high-burden countries between 2000 and 2018. METHODS The Spectrum AIDS Impact Module developed by Avenir Health, UNAIDS, and partners is used to estimate key HIV epidemic indicators from mathematical models. We used 2019 UNAIDS global estimates of children (aged 0-14 years) who are HEU generated by Spectrum and 2017 UN Population Division estimates of the number of all children in each region or country to estimate the regional or national prevalence of children who were HEU, the regional or national contribution of children who were HEU to the global population of children who were HEU, and the proportion of children who were HEU and exposed to antiretrovirals for six UNAIDS regions and 21 HIV high-burden countries in 2018. We also estimated the percentage change in the global population of children who were HEU between 2000 and 2018. FINDINGS In 2018, there were an estimated 14·8 million (lower estimate 11·1-upper estimate 18·3) children who were HEU, 13·2 million (9·8-16·3; 90%) of whom resided in sub-Saharan Africa and 760 000 (640 000-970 000; 5%) of whom resided in the Asia and Pacific region. Five countries accounted for 50% of all 14·8 million children who were HEU globally: South Africa (3·5 million [23·8%]), Uganda (1·1 million [7·5%]), Mozambique (1·0 million [6·6%]), Tanzania (910 000 [6·1%]); and Nigeria (880 000 [6·0%]). In five southern African countries, the prevalence of children who were HEU exceeded 15% of the general child population: eSwatini (32·4%), Botswana (27·4%), South Africa (21·6%), Lesotho (21·1%), and Namibia (16·4%). INTERPRETATION The global population of children who are HEU is substantial, requiring a coordinated strategy to reduce HIV exposure in children and ensure optimal health and wellbeing of children who are HEU and their families. Future research and programmatic funding investments must be aligned with the geographical distribution of children who are HEU. FUNDING National Institutes of Health, International AIDS Society.
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Affiliation(s)
- Amy L Slogrove
- Department of Paediatrics and Child Health and Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Worcester, South Africa.
| | - Kathleen M Powis
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Mary Mahy
- Strategic Information and Evaluation Department, UNAIDS, Geneva, Switzerland
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Mahy M, Marsh K, Sabin K, Wanyeki I, Daher J, Ghys PD. HIV estimates through 2018: data for decision-making. AIDS 2019; 33 Suppl 3:S203-S211. [PMID: 31343430 PMCID: PMC6919227 DOI: 10.1097/qad.0000000000002321] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Global targets call for a 75% reduction in new HIV infections and AIDS deaths between 2010 and 2020. UNAIDS supports countries to measure progress towards these targets. In 2019, this effort resulted in revised national, regional and global estimates reflecting the best available data. METHODS Spectrum software was used to develop estimates for 170 countries. Country teams from 151 countries developed HIV estimates directly and estimates for an additional 19 country were developed by UNAIDS based on available evidence. 107 countries employed models using HIV prevalence data from sentinel surveillance, routinely collected HIV testing and household surveys while the remaining 63 countries applied models using HIV case surveillance and/or reported AIDS deaths. Model parameters were informed by the UNAIDS Reference Group on Estimates, Modeling and Projections. RESULTS HIV estimates were available for 170 countries representing 99% of the global population. An estimated 37.9 million (uncertainty bounds 32.7-44.0 million) people were living with HIV in 2018. There were 1.7 million (1.4-2.3 million) new infections and 770 000 (570 000-1.1 million) AIDS-related deaths. New HIV infections declined in five of eight regions and AIDS deaths were declining in six of eight regions between 2010 and 2018. CONCLUSION The estimates demonstrate progress towards ending the AIDS epidemic by 2030, however, through 2018 declines in new HIV infections and AIDS-related deaths were not sufficient to meet global interim targets. The UNAIDS estimates have made important contributions to guide decisions about the HIV response at global, regional and country level.
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Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents. J Acquir Immune Defic Syndr 2019; 78 Suppl 1:S49-S57. [PMID: 29994920 PMCID: PMC6042862 DOI: 10.1097/qai.0000000000001749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective and Approach: Computer-based simulation models serve an important purpose in informing HIV care for children and adolescents. We review current model-based approaches to informing pediatric and adolescent HIV estimates and guidelines. Findings: Clinical disease simulation models and epidemiologic models are used to inform global and regional estimates of numbers of children and adolescents living with HIV and in need of antiretroviral therapy, to develop normative guidelines addressing strategies for diagnosis and treatment of HIV in children, and to forecast future need for pediatric and adolescent antiretroviral therapy formulations and commodities. To improve current model-generated estimates and policy recommendations, better country-level and regional-level data are needed about children living with HIV, as are improved data about survival and treatment outcomes for children with perinatal HIV infection as they age into adolescence and adulthood. In addition, novel metamodeling and value of information methods are being developed to improve the transparency of model methods and results, as well as to allow users to more easily tailor model-based analyses to their own settings. Conclusions: Substantial progress has been made in using models to estimate the size of the pediatric and adolescent HIV epidemic, to inform the development of guidelines for children and adolescents affected by HIV, and to support targeted implementation of policy recommendations to maximize impact. Ongoing work will address key limitations and further improve these model-based projections.
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Therapeutic Antibody Discovery in Infectious Diseases Using Single-Cell Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1068:89-102. [PMID: 29943298 DOI: 10.1007/978-981-13-0502-3_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the discovery of mouse hybridoma technology by Kohler and Milstein in 1975, significant progress has been made in monoclonal antibody production. Advances in B cell immortalization and phage display technologies have generated a myriad of valuable monoclonal antibodies for diagnosis and treatment. Technological breakthroughs in various fields of 'omics have shed crucial insights into cellular heterogeneity of a biological system in which the functional individuality of a single cell must be considered. Based on this important concept, remarkable discoveries in single-cell analysis have made in identifying and isolating functional B cells that produce beneficial therapeutic monoclonal antibodies. In this review, we will discuss three traditional methods of antibody discovery. Recent technological platforms for single-cell antibody discovery will be reviewed. We will discuss the application of the single-cell analysis in finding therapeutic antibodies for human immunodeficiency virus and emerging Zika arbovirus.
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AbouZahr C, Boerma T, Byass P. Bridging the data gaps: do we have the right balance between country data and global estimates? Glob Health Action 2018; 10:1299978. [PMID: 28532310 PMCID: PMC5645668 DOI: 10.1080/16549716.2017.1299978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Ties Boerma
- b Department of Information, Evidence and Research , WHO , Geneva , Switzerland.,c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Peter Byass
- d Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.,e School of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,f Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
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Boerma T, Victora C, Abouzahr C. Monitoring country progress and achievements by making global predictions: is the tail wagging the dog? Lancet 2018; 392:607-609. [PMID: 29661480 DOI: 10.1016/s0140-6736(18)30586-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 02/18/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Ties Boerma
- University of Manitoba, Winnipeg, MB, Canada.
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San-Juan-Vergara H, Zurek E, Ajami NJ, Mogollon C, Peña M, Portnoy I, Vélez JI, Cadena-Cruz C, Diaz-Olmos Y, Hurtado-Gómez L, Sanchez-Sit S, Hernández D, Urruchurtu I, Di-Ruggiero P, Guardo-García E, Torres N, Vidal-Orjuela O, Viasus D, Petrosino JF, Cervantes-Acosta G. A Lachnospiraceae-dominated bacterial signature in the fecal microbiota of HIV-infected individuals from Colombia, South America. Sci Rep 2018; 8:4479. [PMID: 29540734 PMCID: PMC5852036 DOI: 10.1038/s41598-018-22629-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/05/2018] [Indexed: 02/08/2023] Open
Abstract
HIV infection has a tremendous impact on the immune system's proper functioning. The mucosa-associated lymphoid tissue (MALT) is significantly disarrayed during HIV infection. Compositional changes in the gut microbiota might contribute to the mucosal barrier disruption, and consequently to microbial translocation. We performed an observational, cross-sectional study aimed at evaluating changes in the fecal microbiota of HIV-infected individuals from Colombia. We analyzed the fecal microbiota of 37 individuals via 16S rRNA gene sequencing; 25 HIV-infected patients and 12 control (non-infected) individuals, which were similar in body mass index, age, gender balance and socioeconomic status. To the best of our knowledge, no such studies have been conducted in Latin American countries. Given its compositional nature, microbiota data were normalized and transformed using Aitchison's Centered Log-Ratio. Overall, a change in the network structure in HIV-infected patients was revealed by using the SPIEC-EASI MB tool. Genera such as Blautia, Dorea, Yersinia, Escherichia-Shigella complex, Staphylococcus, and Bacteroides were highly relevant in HIV-infected individuals. Differential abundance analysis by both sparse Partial Least Square-Discriminant Analysis and Random Forest identified a greater abundance of Lachnospiraceae-OTU69, Blautia, Dorea, Roseburia, and Erysipelotrichaceae in HIV-infected individuals. We show here, for the first time, a predominantly Lachnospiraceae-based signature in HIV-infected individuals.
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Affiliation(s)
| | - Eduardo Zurek
- División de Ingenierías, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Nadim J Ajami
- Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Mario Peña
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Ivan Portnoy
- División de Ingenierías, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Jorge I Vélez
- División de Ingenierías, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Christian Cadena-Cruz
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Yirys Diaz-Olmos
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Leidy Hurtado-Gómez
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Silvana Sanchez-Sit
- Maestría en Estadística Aplicada, Universidad del Norte, Barranquilla, Colombia
| | | | | | | | | | | | - Oscar Vidal-Orjuela
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Diego Viasus
- División Ciencias de la Salud, Fundación Universidad del Norte, Barranquilla, Colombia
| | - Joseph F Petrosino
- Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
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AbouZahr C, Boerma T, Hogan D. Global estimates of country health indicators: useful, unnecessary, inevitable? Glob Health Action 2017; 10:1290370. [PMID: 28532307 PMCID: PMC5645718 DOI: 10.1080/16549716.2017.1290370] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The MDG era relied on global health estimates to fill data gaps and ensure temporal and cross-country comparability in reporting progress. Monitoring the Sustainable Development Goals will present new challenges, requiring enhanced capacities to generate, analyse, interpret and use country produced data. OBJECTIVE To summarize the development of global health estimates and discuss their utility and limitations from global and country perspectives. DESIGN Descriptive paper based on findings of intercountry workshops, reviews of literatureon and synthesis of experiences. RESULTS Producers of global health estimates focus on the technical soundness of estimation methods and comparability of the results across countries and over time. By contrast, country users are more concerned about the extent of their involvement in the estimation process and hesitate to buy into estimates derived using methods their technical staff cannot explain and that differ from national data sources. Quantitative summaries of uncertainty may be of limited practical use in policy discussions where decisions need to be made about what to do next. CONCLUSIONS Greater transparency and involvement of country partners in the development of global estimates will help improve ownership, strengthen country capacities for data production and use, and reduce reliance on externally produced estimates.
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Affiliation(s)
| | - Ties Boerma
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Daniel Hogan
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
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