Updates to the Spectrum/AIM model for estimating key HIV indicators at national and subnational levels

John Stover, Robert Glaubius, Lynne Mofenson, Caitlin M. Dugdale, Mary Ann Davies, Gabriela Patten, Constantin Yiannoutsos

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background:The Spectrum/AIM model is used by national programs and UNAIDS to prepare annual estimates of the status of the HIV epidemic in 170 countries. The model and assumptions are updated regularly under the guidance of the UNAIDS Reference Group on Estimates, Modelling and Projections in response to new data, studies and program needs. This article describes the most recent updates for the 2018 round of estimates.Methods:New data on AIDS-related mortality from Europe and Brazil have been used to update mortality rates of those not on antiretroviral therapy (ART). Household survey data and new studies of pregnant women, mothers, and children have been used to improve estimates of the number of HIV-positive pregnant and breastfeeding women and pediatric ART initiation. New tools to estimate geographic variation in HIV prevalence have been used to prepare district estimates of key indicators.Results:The 2018 version of Spectrum includes: New estimates of non-ART AIDS-related mortality by CD4+ count that depend on ART coverage; a procedure to estimate country-specific patterns of HIV incidence by age by fitting to prevalence by age from household surveys; an updated estimate of postpartum transmission with ART started before pregnancy of 0.023% per month; an updated estimate of retention on treatment at delivery of 80% for all women on ART; a somewhat older pattern of ART initiation by age that has 26% of new pediatric patients initiating ART at 10-14 years of age, 18% at 2-4 years of age, and 26% at 5-9 years of age; and a new tool for estimating key HIV indicators at the district level.Conclusion:The new methods and data implemented in the 2018 version of Spectrum allow national programs more flexibility in describing their programs and are intended to improve the estimates of adult mortality and pediatric HIV indicators.

Original languageEnglish (US)
Pages (from-to)S227-S234
JournalAIDS
Volume33
DOIs
StatePublished - Dec 15 2019

Keywords

  • HIV
  • estimates
  • model

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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