The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead

Crabtree-Ramírez, Brenda; Belaunzarán-Zamudio, Pablo F.; Cortés, Claudia; Morales, Miguel A.; Sued, Omar; Sierra‐Madero, Juan; Cahn, Pedro; Pozniak, Anton; Grinsztejn, Beatriz

doi:10.1002/jia2.25468

Cited by 28 publications

(37 citation statements)

References 19 publications

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“…Another potential driver of spatial heterogeneity is population migration. Political conflicts and economic hardships across the region, notably in Venezuela and Central America, have fostered waves of migration that can affect HIV prevention, treatment, and care program [55]. Furthermore, difficulties in acquiring HIV treatment and ART shortages spurs regional migration that can differentially impact HIV care and control programs in bordering countries [55,56].…”

Section: Discussionmentioning

confidence: 99%

“…A key driver of temporal trends in HIV mortality is the implementation of ART treatment programs, which have been incorporated to varying degrees in all Latin American countries and generally led to increases in ART coverage [55]. ART treatment is often a central focus of national HIV programs, but differences in priority and ability to commit resources have likely impacted progress in reducing HIV mortality.…”

Section: Discussionmentioning

confidence: 99%

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Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Cork¹,

Henry²,

Watson³

et al. 2021

BMC Med

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Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Cork¹,

Henry²,

Watson³

et al. 2021

BMC Med

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“…Of those receiving treatment, only 68% are virally suppressed. All Colombians and legal immigrants have access to HIV tests and ART [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The HIV epidemic in Colombia: spatial and temporal trends analysis

et al. 2021

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Background Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. Methods Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. Results While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0–14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45–64 group. The high–high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. Conclusion Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0–14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the ‘coffee belt’ regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

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“…In addition, by the end of 2018 Colombia still had not adopted the Pré-Exposition Pro laxy to HIV . [17][18] Countries that adopted the Universal Treatment and Test for HIVA policy (UTT) have observed an increasing number of PLWHA with suppressed virus load, decreasing HIV incidence and AIDS-related deaths. [19] The fact that our AIDS mortality data shows a pause in a decreasing trend after 2013, among men in the 15-44 age group, should su ciently warn health authorities.…”

Section: Discussionmentioning

confidence: 99%

The HIV Epidemic In Colombia: Spatial And Temporal Trends Analysis

Montana

Ferreira

Cunha

et al. 2020

Preprint

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BACKGROUND – Colombia occupies 4th place among all Latin American countries in HIV/AIDS incidence rates, which have been increasing since the 1980s. There is a paucity of studies which address this trend. In this study we employed spatial and temporal trend analyses to study how the epidemic behaves in Colombian territory. METHODS - Our sample was composed of 72,994 HIV/AIDS cases and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyze the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS – While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality was stabilized. There was a downward trend in HIV/AIDS incidence and AIDS mortality among people between 0 to 14 years of age. An upward trend was observed for HIV/AIDS incidence in people older than 15 years of age and with the highest trend in 65 years and over group. AIDS mortality showed an increased trend in those 65 years old or over. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. The HIV epidemic expanded from the North Caribbean region to Midwest Colombia.CONCLUSION – Sexual tourism and internal or external immigration might be responsible for the highest HIV/AIDS incidence and AIDS mortality rates observed in the Caribbean and Andean regions. Our results showed that Colombia needs to invest in specific and comprehensive public health policies to end HIV by 2030.

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The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead

Cited by 28 publications

References 19 publications

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

The HIV epidemic in Colombia: spatial and temporal trends analysis

The HIV Epidemic In Colombia: Spatial And Temporal Trends Analysis

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The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead

Cited by 28 publications

References 19 publications

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

The HIV epidemic in Colombia: spatial and temporal trends analysis

The HIV Epidemic In Colombia: Spatial And Temporal Trends Analysis﻿

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The HIV Epidemic In Colombia: Spatial And Temporal Trends Analysis