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Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge. Epidemiol Infect 2018; 146:1308-1311. [PMID: 29843838 DOI: 10.1017/s0950268818001346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.
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Joshi R, Faruqui N, Nagarajan SR, Rampatige R, Martiniuk A, Gouda H. Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review. Int J Epidemiol 2018; 47:255-279. [PMID: 29092034 DOI: 10.1093/ije/dyx216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
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Affiliation(s)
- Rohina Joshi
- George Institute for Global Health
- University of New South Wales
- University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alex Martiniuk
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | - Hebe Gouda
- School of Public Health
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD, Australia
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Silhol R, Gregson S, Nyamukapa C, Mhangara M, Dzangare J, Gonese E, Eaton JW, Case KK, Mahy M, Stover J, Mugurungi O. Empirical validation of the UNAIDS Spectrum model for subnational HIV estimates: case-study of children and adults in Manicaland, Zimbabwe. AIDS 2017; 31 Suppl 1:S41-S50. [PMID: 28296799 PMCID: PMC10660499 DOI: 10.1097/qad.0000000000001418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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 with 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, whereas 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. CONCLUSION 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.
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Affiliation(s)
- Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Mutsa Mhangara
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Janet Dzangare
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Elizabeth Gonese
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Kelsey K. Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mary Mahy
- Programme Branch, UNAIDS, Geneva, Switzerland
| | - John Stover
- Avenir Health, Glastonbury, Connecticut, USA
| | - Owen Mugurungi
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
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Larmarange J, Mossong J, Bärnighausen T, Newell ML. Participation dynamics in population-based longitudinal HIV surveillance in rural South Africa. PLoS One 2015; 10:e0123345. [PMID: 25875851 PMCID: PMC4395370 DOI: 10.1371/journal.pone.0123345] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/02/2015] [Indexed: 01/11/2023] Open
Abstract
Population-based HIV surveillance is crucial to inform understanding of the HIV pandemic and evaluate HIV interventions, but little is known about longitudinal participation patterns in such settings. We investigated the dynamics of longitudinal participation patterns in a high HIV prevalence surveillance setting in rural South Africa between 2003 and 2012, taking into account demographic dynamics. At any given survey round, 22,708 to 30,495 persons were eligible. Although the yearly participation rates were relatively modest (26% to 46%), cumulative rates increased substantially with multiple recruitment opportunities: 68% of eligible persons participated at least once, 48% at least twice and 31% at least three times after five survey rounds. We identified two types of study fatigue: at the individual level, contact and consent rates decreased with multiple recruitment opportunities and, at the population level, these rates also decreased over calendar time, independently of multiple recruitment opportunities. Using sequence analysis and hierarchical clustering, we identified three broad individual participation profiles: consenters (20%), switchers (43%) and refusers (37%). Men were over represented among refusers, women among consenters, and temporary non-residents among switchers. The specific subgroup of persons who were systemically not contacted or refusers constitutes a challenge for population-based surveillance and interventions.
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Affiliation(s)
- Joseph Larmarange
- Centre Population & Développement (UMR 196 Paris Descartes Ined IRD), Institut de Recherche pour le Développement, Paris, France
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
| | - Joël Mossong
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Surveillance & Epidemiology of Infectious Diseases, Laboratoire National de Santé, Luxembourg, Luxembourg
| | - Till Bärnighausen
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Marie Louise Newell
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Faculty of Medicine, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
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Abstract
Background: Joint United Nations Programme on HIV/AIDS (UNAIDS) and Murray et al. have both produced sets of estimates for worldwide HIV incidence, prevalence and mortality. Understanding differences in these estimates can strengthen the interpretation of each. Methods: We describe differences in the two sets of estimates. Where possible, we have drawn on additional published data to which estimates can be compared. Findings: UNAIDS estimates that there were 6 million more people living with HIV (PLHIV) in 2013 (35 million) compared with the Murray et al. estimates (29 million). Murray et al. estimate that new infections and AIDS deaths have declined more gradually than does UNAIDS. Just under one third of the difference in PLHIV is in Africa, where Murray et al. have relied more on estimates of adult mortality trends than on data on survival times. Another third of the difference is in North America, Europe, Central Asia and Australasia. Here Murray et al. estimates of new infections are substantially lower than the number of new HIV/AIDS diagnoses reported by countries, whereas published UNAIDS estimate tend to be greater. The remaining differences are in Latin America and Asia where the data upon which the UNAIDS methods currently rely are more sparse, whereas the mortality data leveraged by Murray et al. may be stronger. In this region, however, anomalies appear to exist between the both sets of estimates and other data. Interpretation: Both estimates indicate that approximately 30 million PLHIV and that antiretroviral therapy has driven large reductions in mortality. Both estimates are useful but show instructive discrepancies with additional data sources. We find little evidence to suggest that either set of estimates can be considered systematically more accurate. Further work should seek to build estimates on as wide a base of data as possible.
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Todd J, Slaymaker E, Zaba B, Mahy M, Byass P. Measuring HIV-related mortality in the first decade of anti-retroviral therapy in sub-Saharan Africa. Glob Health Action 2014; 7:24787. [PMID: 24852247 PMCID: PMC4032059 DOI: 10.3402/gha.v7.24787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jim Todd
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Emma Slaymaker
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Basia Zaba
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Mary Mahy
- Epidemiology Section, UNAIDS, Geneva, Umeå Centre for Global Health Research, Department of Public
| | - Peter Byass
- Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Slaymaker E, Todd J, Marston M, Calvert C, Michael D, Nakiyingi-Miiro J, Crampin A, Lutalo T, Herbst K, Zaba B. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa. Glob Health Action 2014; 7:22789. [PMID: 24762982 PMCID: PMC3999950 DOI: 10.3402/gha.v7.22789] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Methods Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. Results 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14–46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32–0.58), compared to the period before ART was available, in mortality at ages 15–54 across all five sites. Discussion Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further.
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Affiliation(s)
- Emma Slaymaker
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK;
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK; TAZAMA Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Milly Marston
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Denna Michael
- TAZAMA Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Jessica Nakiyingi-Miiro
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Research Unit on AIDS, Entebbe, Uganda
| | - Amelia Crampin
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi
| | - Tom Lutalo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Kobus Herbst
- The Africa Centre for Health and Population Studies, University of KwaZulu-Natal (UKZN), Somkhele, South Africa
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Tenu F, Isingo R, Zaba B, Urassa M, Todd J. Adjusting the HIV prevalence for non-respondents using mortality rates in an open cohort in northwest Tanzania. Trop Med Int Health 2014; 19:656-663. [PMID: 24655037 PMCID: PMC5396574 DOI: 10.1111/tmi.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To estimate HIV prevalence in adults who have not tested for HIV using age‐specific mortality rates and to adjust the overall population HIV prevalence to include both tested and untested adults. Methods An open cohort study was established since 1994 with demographic surveillance system (DSS) and five serological surveys conducted. Deaths from Kisesa DSS were used to estimate mortality rates and 95% confidence intervals by HIV status for 3‐ 5‐year periods (1995–1999, 2000–2004, and 2005–2009). Assuming that mortality rates in individuals who did not test for HIV are similar to those in tested individuals, and dependent on age, sex and HIV status and HIV, prevalence was estimated. Results In 1995–1999, mortality rates (per 1000 person years) were 43.7 (95% CI 35.7–53.4) for HIV positive, 2.6 (95% CI 2.1–3.2) in HIV negative and 16.4 (95% CI 14.4–18.7) in untested. In 2000–2004, mortality rates were 43.3 (95% CI 36.2–51.9) in HIV positive, 3.3 (95% CI 2.8–4.0) in HIV negative and 11.9 (95% CI 10.5–13.6) in untested. In 2005–2009, mortality rates were 30.7 (95% CI 24.8–38.0) in HIV positive, 4.1 (95% CI 3.5–4.9) in HIV negative and 5.7 (95% CI 5.0–6.6) in untested residents. In the three survey periods (1995–1999, 2000–2004, 2005–2009), the adjusted period prevalences of HIV, including the untested, were 13.5%, 11.6% and 7.1%, compared with the observed prevalence in the tested of 6.0%, 6.8 and 8.0%. The estimated prevalence in the untested was 33.4%, 21.6% and 6.1% in the three survey periods. Conclusion The simple model was able to estimate HIV prevalence where a DSS provided mortality data for untested residents.
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Affiliation(s)
- Filemon Tenu
- Amani Research Centre, Muheza, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Basia Zaba
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jim Todd
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Mwanza Research Centre, Mwanza, Tanzania.,London School of Hygiene and Tropical Medicine, London, UK
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Kanjala C, Michael D, Todd J, Slaymaker E, Calvert C, Isingo R, Wringe A, Zaba B, Urassa M. Using HIV-attributable mortality to assess the impact of antiretroviral therapy on adult mortality in rural Tanzania. Glob Health Action 2014; 7:21865. [PMID: 24656167 PMCID: PMC3962553 DOI: 10.3402/gha.v7.21865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 01/15/2014] [Accepted: 02/10/2014] [Indexed: 11/14/2022] Open
Abstract
Background The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART) to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007 showed a slow uptake of ART and a modest impact on mortality. Additional data from the 2010 HIV serological survey provide an opportunity to update the estimated impact of ART in this setting. Methods The Kisesa Health and Demographic Surveillance Site (HDSS) has collected HIV serological data and demographic data, including verbal autopsy (VA) interviews since 1994. Serological data to the end of 2010 were used to make two estimates of HIV-attributable mortality, the first among HIV positives using the difference in mortality between HIV positives and HIV negatives, and the second in the population using the difference between the observed mortality rate in the whole population and the mortality rate among the HIV negatives. Four time periods (1994–1999, 2000–2004, 2005–2007, and 2008–2010) were used and HIV-attributable mortality estimates were analysed in detail for trends over time. A computer algorithm, InterVA-4, was applied to VA data to estimate the HIV-attributable mortality for the population, and this was compared to the estimates from the serological survey data. Results Among HIV-positive adults aged 45–59 years, high mortality rates were observed across all time periods in both males and females. In HIV-positive men, the HIV-attributable mortality was 91.6% (95% confidence interval (CI): 84.6%–95.3%) in 2000–2004 and 86.3% (95% CI: 71.1%–93.3%) in 2008–2010, while among women, the HIV-attributable mortality was 87.8% (95% CI: 71.1%–94.3%) in 2000–2004 and 85.8% (95% CI: 59.6%–94.4%) in 2008–2010. In the whole population, using the serological data, the HIV-attributable mortality among men aged 30–44 years decreased from 57.2% (95% CI: 46.9%–65.3%) in 2000–2004 to 36.5% (95% CI: 18.8%–50.1%) in 2008–2010, while among women the corresponding decrease was from 57.3% (95% CI: 49.7%–63.6%) to 38.7% (95% CI: 27.4%–48.2%). The HIV-attributable mortality in the population using estimates from the InterVA model was lower than that from HIV sero-status data in the period prior to ART, but slightly higher once ART became available. Discussion In the Kisesa HDSS, ART availability corresponds with a decline in adult overall mortality, although not as large as expected. Using InterVA to estimate HIV-attributable mortality showed smaller changes in HIV-related mortality following ART availability than the serological results.
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Affiliation(s)
- Chifundo Kanjala
- National Institute for Medical Research, Mwanza, Tanzania; London School of Hygiene and Tropical Medicine, London, UK;
| | - Denna Michael
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- National Institute for Medical Research, Mwanza, Tanzania; London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Slaymaker
- London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- London School of Hygiene and Tropical Medicine, London, UK
| | - Raphael Isingo
- National Institute for Medical Research, Mwanza, Tanzania
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
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