Estimating HIV incidence from surveillance data indicates a second wave of infections in Brazil

Autor: Ana Roberta Pati Pascom, Juan F. Vesga, Timothy B. Hallett, Tara D. Mangal, Adele Schwartz Benzaken, Mariana Veloso Meireles
Přispěvatelé: Bill & Melinda Gates Foundation, Medical Research Council (MRC)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Epidemiology
Human immunodeficiency virus (HIV)
HIV Infections
medicine.disease_cause
0302 clinical medicine
Credible interval
030212 general & internal medicine
High rate
Incidence
Hiv incidence
virus diseases
Incidence estimation
Middle Aged
HIV care cascade
PREVALENCE
Natural history
Infectious Diseases
AIDS EPIDEMIC
SURVIVAL
HIV/AIDS
Female
Life Sciences & Biomedicine
Brazil
Healthcare system
Adult
Surveillance data
Adolescent
DEATHS
030231 tropical medicine
Microbiology
Article
lcsh:Infectious and parasitic diseases
1117 Public Health and Health Services
Young Adult
03 medical and health sciences
Age Distribution
Acquired immunodeficiency syndrome (AIDS)
Virology
medicine
Humans
lcsh:RC109-216
Science & Technology
business.industry
Public Health
Environmental and Occupational Health
Bayes Theorem
1103 Clinical Sciences
medicine.disease
TRENDS
CD4 Lymphocyte Count
MODEL
Parasitology
business
Deterministic model
Demography
Zdroj: Epidemics, Vol 27, Iss, Pp 77-85 (2019)
Epidemics
Popis: Highlights • We combined four surveillance networks of HIV/AIDS monitoring in Brazil. • We used an age-structured deterministic model to infer HIV incidence. • By 2001 a second wave of HIV infections was occurring in Brazil. • There were persistent differences in linkage to care by sex. • Of 838,000 people living with HIV by 2015, 80% were diagnosed and reported.
Emerging evidence suggests that HIV incidence rates in Brazil, particularly among men, may be rising. Here we use Brazil’s integrated health systems data to develop a mathematical model, reproducing the complex surveillance systems and providing estimates of HIV incidence, number of people living with HIV (PLHIV), reporting rates and ART initiation rates. An age-structured deterministic model with a flexible spline was used to describe the natural history of HIV along with reporting and treatment rates. Individual-level surveillance data for 1,077,295 cases (HIV/AIDS diagnoses, ART dispensations, CD4 counts and HIV/AIDS-related deaths) were used to calibrate the model using Bayesian inference. The results showed a second wave of infections occurring after 2001 and 56,000 (95% Credible Interval 43,000–71,000) new infections in 2015, 37,000 (95% CrI 28,000–54,000) infections in men and 16,000 (95% CrI 10,000–23,000) in women. The estimated number of PLHIV by end-2015 was 838,000 (95% CrI 675,000–1,083,000), with 80% (95% CrI 62–98%) of those individuals reported to the Ministry of Health. Women were more likely to be diagnosed and reported than men; 86.8% of infected women had been reported compared with 75.7% of men. Likewise, ART initiation rates for women were higher than those for men. The second wave contradicts previous estimates of HIV incidence trends in Brazil and there were persistent differences in the rates of accessing care between men and women. Nevertheless, the Brazilian HIV program has achieved high rates of detection and treatment, making considerable progress over the past ten years.
Databáze: OpenAIRE
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