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@article{Eaton:2019:10.1097/QAD.0000000000002437,
author = {Eaton, JW and Brown, T and Puckett, R and Glaubius, R and Mutai, K and Bao, L and Salomon, JA and Stover, J and Mahy, M and Hallett, TB},
doi = {10.1097/QAD.0000000000002437},
journal = {AIDS},
pages = {S235--S244},
title = {The estimation and projection package age-sex model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.},
url = {http://dx.doi.org/10.1097/QAD.0000000000002437},
volume = {33},
year = {2019}
}

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TY  - JOUR
AB  - OBJECTIVES: Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA). DESIGN: Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data. METHODS: We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form for the HIV transmission rate, termed 'r-hybrid', which combines a four-parameter logistic function for the initial epidemic growth, peak, and decline followed by a first-order random walk for recent trends after epidemic stabilization. We fitted the r-hybrid model along with previously developed r-spline and r-trend models to HIV prevalence data from household surveys and ANC-SS in 177 regions in 34 SSA countries. We used leave-one-out cross validation with household survey HIV prevalence to compare model predictions. RESULTS: The r-hybrid and r-spline models typically provided similar HIV prevalence trends, but sometimes qualitatively different assessments of recent incidence trends because of different structural assumptions about the HIV transmission rate. The r-hybrid model had the lowest average continuous ranked probability score, indicating the best model predictions. Coverage of 95% posterior predictive intervals was 91.5% for the r-hybrid model, versus 87.2 and 85.5% for r-spline and r-trend, respectively. CONCLUSION: The EPP-ASM and r-hybrid models improve consistency of EPP and Spectrum, improve the epidemiological assumptions underpinning recent HIV incidence estimates, and improve estimates and short-term projections of HIV prevalence trends. Countries that use general population survey and ANC-SS data to estimate HIV epidemic trends should consider using these tools.
AU  - Eaton,JW
AU  - Brown,T
AU  - Puckett,R
AU  - Glaubius,R
AU  - Mutai,K
AU  - Bao,L
AU  - Salomon,JA
AU  - Stover,J
AU  - Mahy,M
AU  - Hallett,TB
DO  - 10.1097/QAD.0000000000002437
EP  - 244
PY  - 2019///
SN  - 0269-9370
SP  - 235
TI  - The estimation and projection package age-sex model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.
T2  - AIDS
UR  - http://dx.doi.org/10.1097/QAD.0000000000002437
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31800403
UR  - https://insights.ovid.com/crossref?an=00002030-201912153-00005
UR  - http://hdl.handle.net/10044/1/75693
VL  - 33
ER  -

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