Producing HIV estimates: from global advocacy to country planning and impact measurement

Abstract

Background: The development of global HIV estimates has been critical for understanding, advocating for and funding the HIV response. The process of generating HIV estimates has been cited as the gold standard for public health estimates. Objective: This paper provides important lessons from an international scientific collaboration and provides a useful model for those producing public health estimates in other fields. Design: Through the compilation and review of published journal articles, United Nations reports, other documents and personal experience we compiled historical information about the estimates and identified potential lessons for other public health estimation efforts. Results: Through the development of core partnerships with country teams, implementers, demographers, mathematicians, epidemiologists and international organizations, UNAIDS has led a process to develop the capacity of country teams to produce internationally comparable HIV estimates. The guidance provided by these experts has led to refinements in the estimated numbers of people living with HIV, new HIV infections and AIDS-related deaths over the past 20 years.A number of important updates to the methods since 1997 resulted in fluctuations in the estimated levels, trends and impact of HIV. The largest correction occurred between the 2005 and 2007 rounds with the additions of household survey data into the models. In 2001 the UNAIDS models at that time estimated there were 40 million people living with HIV. In 2016, improved models estimate there were 30 million (27.6–32.7 million) people living with HIV in 2001. Conclusions: Country ownership of the estimation tools has allowed for additional uses of the results than had the results been produced by researchers or a team in Geneva. Guidance from a reference group and input from country teams have led to critical improvements in the models over time. Those changes have improved countries’ and stakeholders’ understanding of the HIV epidemic.

A Lachnospiraceae-dominated bacterial signature in the fecal microbiota of HIV-infected individuals from Colombia, South America

“…Approximately 78 million people have been diagnosed with HIV, of whom ~35 million people have died. In 2015 alone, there were 36.7 million people living with HIV 1 , 2 . Among the 4 HIV groups, M is the most widely distributed group and is comprised of nine subtypes.…”

Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents

“… 36 , 38 – 41 For example, UNAIDS makes country Spectrum files, Spectrum software, and training manuals available online; for official users of the model, proficiency with these documents is supplemented by biennial, regional training workshops. 42 , 43 The CEPAC model includes more than 30,000 lines of code and more than 28,000 input parameters; to avoid errors in inputs and execution, collaborating investigators undertake in-person trainings, usually 3–12 months in duration, at the team's research offices in Boston. 7 , 44 , 45 Online tools and metamodeling methods can address these limitations in access.…”

Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study

“…Individual countries generate annual national or sub national epidemic indicator estimates using the Spectrum software. 17 These national estimates are validated and collated by UNAIDS to develop regional and global estimates. All historic estimates for previous years are updated with the current model incorporating the most up-to-date knowledge of the HIV epidemic.…”