Assessment of epidemic projections using recent HIV survey data in South Africa: a validation analysis of ten mathematical models of HIV epidemiology in the antiretroviral therapy era
Assessment of epidemic projections using recent HIV survey data in South Africa: a validation analysis of ten mathematical models of HIV epidemiology in the antiretroviral therapy era
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DOI：
10.1016/s2214-109x(15)00080-7
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发表时间：
2015-10-01
影响因子：
34.3
通讯作者：
Hallett, Timothy B.
中科院分区：
文献类型：
--
作者：
Eaton, Jeffrey W.;Bacaer, Nicolas;Hallett, Timothy B.
背景数学模型被广泛用于模拟控制艾滋病毒的干预措施的效果，并预测未来的流行病学趋势和资源需求。我们的目的是验证过去的模型预测的数据从一个大的家庭调查在南非在2012.Methods我们比较了10个模型预测的艾滋病毒感染率，艾滋病毒的发病率，抗逆转录病毒治疗（ART）的覆盖率从2012年全国家庭调查数据的估计。2012年的模式预测是在2012年住户调查公布之前作出的。我们比较了成人（年龄15-49岁）2012年的艾滋病毒流行率，2008年至2012年流行率的变化，以及模型预测和2012年家庭调查之间按性别和年龄组划分的流行率、发病率和ART覆盖率。（18.8%），8个模型的中心预测低于调查的95%CI（17.5-20.3）。8个模型预测，2008年至2012年期间艾滋病毒流行率将保持不变（n=5）或下降（n=3），而住户调查的流行率估计数从2008年的16.9%上升到2012年的18.8%（差异1.9，95% CI -0.1至3.9）。模型预测准确地预测了15-24岁年轻人的患病率下降1.6个百分点（95% CI -0.3至3.5），50岁及以上人群的患病率上升2.2个百分点（0.5至3.9）。模型准确地代表了2012年接受抗逆转录病毒治疗的成年人数量; 10个模型中有6个在调查的95%CI 154 - 212万之间。然而，女性和男性之间的差异ART覆盖率并没有完全捕获;所有模型预测的性别比例的女性对男性的ART低于调查估计的2.22（95%CI 1.73-2.71）。解释预测艾滋病毒流行病的整体下降在ART时代可能是乐观的。未来的治疗和艾滋病毒预防需求可能比以前预测的更大。关于艾滋病毒护理服务提供的更多数据可能有助于提供更准确的预测。
Background Mathematical models are widely used to simulate the effects of interventions to control HIV and to project future epidemiological trends and resource needs. We aimed to validate past model projections against data from a large household survey done in South Africa in 2012.Methods We compared ten model projections of HIV prevalence, HIV incidence, and antiretroviral therapy (ART) coverage for South Africa with estimates from national household survey data from 2012. Model projections for 2012 were made before the publication of the 2012 household survey. We compared adult (age 15-49 years) HIV prevalence in 2012, the change in prevalence between 2008 and 2012, and prevalence, incidence, and ART coverage by sex and by age groups between model projections and the 2012 household survey.Findings All models projected lower prevalence estimates for 2012 than the survey estimate (18.8%), with eight models' central projections being below the survey 95% CI (17.5-20.3). Eight models projected that HIV prevalence would remain unchanged (n=5) or decline (n=3) between 2008 and 2012, whereas prevalence estimates from the household surveys increased from 16.9% in 2008 to 18.8% in 2012 (difference 1.9, 95% CI -0.1 to 3.9). Model projections accurately predicted the 1.6 percentage point prevalence decline (95% CI -0.3 to 3.5) in young adults aged 15-24 years, and the 2.2 percentage point (0.5 to 3.9) increase in those aged 50 years and older. Models accurately represented the number of adults on ART in 2012; six of ten models were within the survey 95% CI of 1.54-2.12 million. However, the differential ART coverage between women and men was not fully captured; all model projections of the sex ratio of women to men on ART were lower than the survey estimate of 2.22 (95% CI 1.73-2.71).Interpretation Projections for overall declines in HIV epidemics during the ART era might have been optimistic. Future treatment and HIV prevention needs might be greater than previously forecasted. Additional data about service provision for HIV care could help inform more accurate projections.