1.  Title: [Global Burden of Diseases, Injuries and Risk Factors Study] operations manual. Final draft. Author: Harvard University; University of Washington. Institute for Health Metrics and Evaluation; Johns Hopkins University; University of Queensland; World Health Organization [WHO] Source: [Cambridge, Massachusetts, Harvard University, 2009 Jan 20 142 p. Abstract: The final draft of the Global Burden of Diseases, Injuries and Risk Factors Study Operations Manual is intended to serve as a guide for the Expert Groups working on the GBD Study. There are opportunities to provide input and feedback, and instructions to do so are included in the operations manual. The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization WHO). It is the first major effort since the GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. By November 2010 the project will produce a final set of estimates. (Excerpts) Language: English Keywords: GLOBAL | MANUAL | DATA ANALYSIS | ESTIMATION TECHNIQUES | DISABLED PERSONS AND DISABILITIES | DISEASES | ACCIDENTS AND INJURIES | MORTALITY | RISK FACTORS | EPIDEMIOLOGY | INCIDENCE | PREVALENCE | RISK ASSESSMENT | BIAS | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Population Dynamics | Public Health | Measurement | Evaluation | Error Sources Document Number: 331797 |
| 2. Title: Development of Assays to Estimate HIV Incidence. Meeting proceedings, Chapel Hill, North Carolina, May 13-14, 2009. Author: Meeting on the Development of Assays to Estimate HIV Incidence (2009: Chapel Hill) Source: [Research Triangle Park], North Carolina, Family Health International [FHI], 2009. [70] p. Abstract: Family Health International (FHI) convened a meeting on the Development of Assays to Estimate HIV Incidence on May 13-14, 2009 at the Carolina Inn in Chapel Hill, North Carolina. The purpose of this meeting was to assess how new and existing technologies and research could be applied to advance the development of assays to estimate HIV incidence. Nearly fifty leading experts including immunologists, epidemiologists, HIV transmission experts, assay developers, virologists, industry representatives, and potential users of assays participated in the meeting. The meeting was primarily supported by the Bill & Melinda Gates Foundation and in conjunction with and the support of the World Health Organization (WHO), the HIV Prevention Trials Network (HPTN), and the Center for HIV / AIDS Vaccine Immunology (CHAVI). (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | RESEARCH METHODOLOGY | VALIDITY | ESTIMATION TECHNIQUES | INCIDENCE | EPIDEMIOLOGY | STUDY DESIGN | HIV INFECTIONS | AWARENESS | TREATMENT | PROGRAM ACTIVITIES | PROGRAM EVALUATION | Measurement | Public Health | Health | Viral Diseases | Diseases | Knowledge | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Programs | Organization and Administration Document Number: 331753 |
3.  Peer Reviewed Title: Overestimating HIV infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi. Author: Anglewicz P; Kohler HP Source: Demographic Research. 2009;20(6):65-96. Abstract: In the absence of HIV testing, how do rural Malawians assess their HIV status? In this paper, we use a unique dataset that includes respondents' HIV status as well as their subjective likelihood of HIV infection. These data show that many rural Malawians overestimate their likelihood of current HIV infection. The discrepancy between actual and perceived status raises an important question: Why are so many wrong? We begin by identifying determinants of self-assessed HIV status, and then compare these assessments with HIV biomarker results. Finally, we ask what characteristics of individuals are associated with errors in self-assessments. Language: English Keywords: MALAWI | RESEARCH REPORT | RURAL AREAS | RESPONDENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | ESTIMATION TECHNIQUES | PROBABILITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Statistical Studies Document Number: 342533 |
| 4. Title: Estimating HIV-1 incidence using the serologic testing algorithm for recent HIV infections at HIV counseling and testing centers in the city of Sao Paulo, Brazil. Author: Bassichetto KC; Bergamaschi DP; Veras MA; Sucupira MC; Mesquita F; Diaz RS Source: Brazilian Journal of Infectious Diseases. 2009 Feb;13(1):9-12. Abstract: The network of HIV counseling and testing centers in Sao Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females. Language: English Keywords: BRAZIL | RESEARCH REPORT | ESTIMATION TECHNIQUES | STATISTICAL STUDIES | CLIENTS | HIV TESTING | HIV INFECTIONS | INCIDENCE | LABORATORY PROCEDURES | EPIDEMIOLOGY | PREVALENCE | TIME FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Public Health | Population Dynamics | Demographic Factors | Population Document Number: 342655 |
| 5. Peer Reviewed Title: Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Author: Chopra M; Daviaud E; Pattinson R; Fonn S; Lawn JE Source: Lancet. 2009 Sep 5;374(9692):835-46. Abstract: South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ECONOMIC MODEL | EXCESS MORTALITY | CAUSES OF DEATH | HIV INFECTIONS | INTERVENTIONS | IMPLEMENTATION | HEALTH POLICY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Mortality | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Health Services | Delivery of Health Care | Health | Management Document Number: 342802 |
| 6. Peer Reviewed Title: Estimation of the predictive role of plasma viral load on CD4 decline in HIV-1 subtype C-infected subjects in India. Author: Ding M; Tarwater P; Rodriguez M; Chatterjee R; Ratner D; Yamamura Y; Roy P; Mellors J; Neogi D; Chen Y; Gupta P Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):119-25. Abstract: BACKGROUND: Plasma viral load has been shown to be a meaningful prognostic marker for disease progression in untreated, HIV-1 subtype B-infected subjects in United States and Western Europe and therefore used as a prognostic marker for disease progression. Because of high expenses of commercially available viral load assays, the role of viral load in disease progression has not been evaluated in HIV-1 subtype C-infected patients in India. METHODS: We developed an inexpensive real-time reverse transcriptase-polymerase chain reaction assay to quantify viral load in plasma of HIV-1 subtype C-infected subjects from India and used it in a longitudinal analysis of viral load and CD4 cell number in HIV-infected subjects from Calcutta, India. RESULTS: The real-time reverse transcriptase-polymerase chain reaction assay can quantify plasma viral load with a linear range of detection from 10 to 10 HIV-1 RNA copies per input. Longitudinal analysis of viral load in a cohort of 39 subjects over an average period of approximately 3 years indicates that 1-log increase in HIV-1 RNA level was associated with a decline of 67 CD4 cell count. Furthermore, HIV-1 RNA level between 500 and 50,000 copies per milliliter would predict a 12.9% decrease in CD4 cell count per year, whereas HIV-1 RNA levels above 50,000 copies HIV-1 RNA per milliliter would predict a 25.3% decrease in CD4 cells per year. In addition, we estimated that the mean incubation period of disease development, as defined by the loss of CD4 below 200, is 8.2 years. CONCLUSION: Our report on the level of viral load on predicting CD4 decline in Indian subjects with HIV-1 provides an additional important tool to the physicians for treating and planning a therapeutic strategy to control HIV-1 infection in India. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | ESTIMATION TECHNIQUES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | HIV INFECTIONS | COST EFFECTIVENESS | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNITY, CELLULAR | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology Document Number: 330366 |
| 7. Peer Reviewed Title: Self-medication prevalence for sexually transmitted diseases: meta-analysis and meta-regression of population level determinants. Author: Gomez GB; Garnett GP; Ward H Source: Sexually Transmitted Diseases. 2009 Feb;36(2):112-9. Abstract: BACKGROUND: Estimated prevalence of self-medication for sexually transmitted diseases (STDs) in observational studies differs between studies and it may vary according to population characteristics. METHODS: We investigated the extent of self-medication use for STD and explored population and study level factors correlated to the variability observed between populations. Medical databases were systematically searched for published studies. Crude prevalence data were extracted. Pooled estimates were calculated using random effects models. Univariate and multivariate meta-regression models with categorical population level covariates were constructed. RESULTS: Of the 35 studies that met the inclusion criteria for all self-medication use, 20 were also included in the analysis of antibiotic only use. There was significant heterogeneity present across prevalence estimates for all self-medication, Q = 3954.82, P <0.001; and among antibiotic only self-medication, Q = 3797.94, P <0.001. In meta-regression analyses, publication year seemed to explain 22.5% of variation among studies of self-medication with antibiotic only. No other significant associations with population or study characteristics were found. CONCLUSIONS: No population level factors leading to high levels of self-medication use for STD were identified. Publications before year 2000 seem to present a higher prevalence of antibiotic use for self-medication. Greater risk awareness of antibiotic misuse and improved control of antibiotic availability at population level might explain this result. An analysis of individual level characteristics should indicate which are influential and whether their local prevalence can explain the observed heterogeneity better. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | KAP SURVEYS | EPIDEMIOLOGIC METHODS | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | TARGET POPULATION | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | SELF CARE | ANTIBIOTICS | DEMOGRAPHIC FACTORS | Developed Countries | North America | Americas | Research Methodology | Theoretical Models | Surveys | Sampling Studies | Studies | Data Analysis | Program Design | Programs | Organization and Administration | Reproductive Tract Infections | Infections | Diseases | Measurement | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Population Document Number: 330365 |
| 8. Peer Reviewed Title: Errors in 'BED'-derived estimates of HIV incidence will vary by place, time and age. Author: Hallett TB; Ghys P; Barnighausen T; Yan P; Garnett GP Source: PloS One. 2009;4(5):e5720. Abstract: BACKGROUND: The BED Capture Enzyme Immunoassay, believed to distinguish recent HIV infections, is being used to estimate HIV incidence, although an important property of the test--how specificity changes with time since infection--has not been not measured. METHODS: We construct hypothetical scenarios for the performance of BED test, consistent with current knowledge, and explore how this could influence errors in BED estimates of incidence using a mathematical model of six African countries. The model is also used to determine the conditions and the sample sizes required for the BED test to reliably detect trends in HIV incidence. RESULTS: If the chance of misclassification by BED increases with time since infection, the overall proportion of individuals misclassified could vary widely between countries, over time, and across age-groups, in a manner determined by the historic course of the epidemic and the age-pattern of incidence. Under some circumstances, changes in BED estimates over time can approximately track actual changes in incidence, but large sample sizes (50,000+) will be required for recorded changes to be statistically significant. CONCLUSIONS: The relationship between BED test specificity and time since infection has not been fully measured, but, if it decreases, errors in estimates of incidence could vary by place, time and age-group. This means that post-assay adjustment procedures using parameters from different populations or at different times may not be valid. Further research is urgently needed into the properties of the BED test, and the rate of misclassification in a wide range of populations. Language: English Keywords: AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | HIV INFECTIONS | IMMUNOLOGICAL EFFECTS | INCIDENCE | TESTING | LABORATORY PROCEDURES | ERROR SOURCES | TIME FACTORS | Developing Countries | Research Methodology | Theoretical Models | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population Document Number: 342159 |
| 9. Peer Reviewed Title: The burden of HIV-associated cryptococcal disease [editorial] Author: Harrison TS Source: AIDS. 2009 Feb 20;23(4):531-2. Abstract: In this issue, Park et al. from the Centers for Disease Control, University of Alabama, and Johannesburg, South Africa, have made the first attempt to estimate the global burden of HIV-associated cryptococcal infection. As clearly stated by the authors, the estimates are exactly that -estimates, which rely on the quality of the data on which they are based. Nevertheless, the results are striking, especially for sub-Saharan Africa, where the estimated number of deaths associated with cryptococcal disease, at half a million per year, is comparable with the number attributed to tuberculosis, a much more frequent infection, but one for which we have much more effective and widely available therapy. So are these results credible? The data are sparse, with just three incidence studies driving the estimates for sub- Saharan Africa (ruling out the possibility of evaluating or taking account of possible intraregional differences in incidence); and the reported incidences are variable, resulting in wide ranges for the estimates of cases and associated deaths. However, biases are as possible on the downside as on the upside. As the authors acknowledge, the relatively low incidence estimate from a South African study with which some of the same authors were involved was likely affected by incomplete case ascertainment. (excerpt) Language: English Keywords: GLOBAL | CRITIQUE | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | PREVALENCE | CAUSES OF DEATH | DEATH RATE | ANTIRETROVIRAL THERAPY | CENTRAL NERVOUS SYSTEM EFFECTS | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Central Nervous System | Physiology | Biology Document Number: 341160 |
| 10. Title: [HIV prevalence in sub-Saharan Africa: background of an estimation] Prevalences du VIH en Afrique sub-saharienne: historique d'une estimation. Author: Larmarange J Source: Medecine Sciences. 2009 Jan;25(1):87-92. Abstract: In 2008 UNAIDS global report on AIDS, the number of people living with HIV in sub-Saharan Africa was estimated at 22 millions in 2007 and 20.4 millions in 2001, while in the 2002 report, the same estimation for 2001 was 28.5 millions. Changes in UNAIDS reflects evolutions of data sources and methods used for the estimates. Sentinel surveillance of pregnant women attending antenatal clinics (ANC) was developed in 1980's with the WHO recommendation of unlinked anonymous testing approach. The objective was not to be representative but to monitor trends. In the 1990's, as ANC data were available, they were used by EpiModel, a model developed by WHO for HIV prevalence estimates from 1992 to 2000. In 2002, a new epidemiological model called EPP (Estimation and Projection Package) was developed by the UNAIDS Reference Group on Estimates, Modelling and Projections, which, in countries with a generalised epidemic, is still based on ANC data collected over time. Since 2001, many countries have conducted national population-based surveys (NPS). Their results have often diverged from estimates based on ANC data. This was explained by the under-representation of rural clinics in sentinel surveillance and relative small participation rate in NPS. Since, several studies have shown that the impact of several biases (participation rate, non-household members, serological window of tests...) in NPS remains relatively low. NPS constitute a good indicator of HIV prevalence level. If pregnant women can be locally representative of the general population, at the national scale, it depends of the localization of selected clinics. But ANC provides data over time, which is not the case for NPS. The current approach of UNAIDS consists in estimating HIV prevalence trends from ANC and the level of the epidemics from NPS. But the hypothesis that ANC data are representative of trends still needs to be verified when several NPS will be available for a same country. Language: French Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | CLINIC VISITS | ANTENATAL CARE | Africa | Developing Countries | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 330885 |
| 11. Peer Reviewed Title: New methods for estimating the tuberculosis case detection rate in high-HIV prevalence countries: the example of Kenya. Author: Mansoer J; Scheele S; Floyd K; Dye C; Sitienei J; Williams B Source: Bulletin of the World Health Organization. 2009 Mar;87(3):186-92, 192A-192B. Abstract: OBJECTIVE: To develop new methods for estimating the sputum smear-positive tuberculosis case detection rate (CDR) in a country where infection with HIV is prevalent. METHODS: We estimated the smear-positive tuberculosis CDR in HIV-negative and HIV-positive adults, and in all adults in Kenya. Data on time trends in tuberculosis case notification rates and on HIV infection prevalence in adults and in tuberculosis patients were used, along with data on tuberculosis control programme performance. FINDINGS: In 2006, the estimated smear-positive tuberculosis CDR in HIV-negative adults was 79% (95% confidence interval, CI: 64-94) and in HIV-positive adults, 57% (95% CI: 26-88), giving a weighted mean of 68% (95% CI: 49-87). The separate estimate for all smear-positive tuberculosis cases was 72% (95% CI: 53-91), giving an overall average for the three estimates of 70% (95% CI: 58-82). As the tuberculosis CDR in 1996 was 57% (95% CI: 47-67), the estimated increase by 2006 was 13 percentage points (95% CI: 6-20), or 23%. This increase was accompanied by a more than doubling of the resources devoted to tuberculosis control in Kenya, including facilities and staff. CONCLUSION: Using three approaches to estimate the tuberculosis CDR in a country where HIV infection is prevalent, we showed that expansion of the tuberculosis control programme in Kenya led to an increase of 23% in the CDR between 1996 and 2006. While the methods developed here can be applied in other countries with a high prevalence of HIV infection, they rely on precise data on trends in such prevalence in the general population and among tuberculosis patients. Language: English Keywords: KENYA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ADULTS | TUBERCULOSIS | INCIDENCE | TRANSMISSION | HIV INFECTIONS | PREVALENCE | EPIDEMICS | COMMUNICABLE DISEASE CONTROL | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Measurement | Viral Diseases | Health Services | Delivery of Health Care | Health Document Number: 342352 |
| 13. Title: Does health aid matter? Author: Mishra P; Newhouse D Source: Journal of Health Economics. 2009 Jun 13; Abstract: This paper examines the relationship between health aid and infant mortality, using data from 118 countries between 1973 and 2004. Health aid has a beneficial and statistically significant effect on infant mortality: doubling per capita health aid is associated with a 2 percent reduction in the infant mortality rate. For the average country, this implies that increasing per capita health aid by US$1.60 per year is associated with 1.5 fewer infant deaths per thousand births. The estimated effect is small, relative to the 2015 target envisioned by the Millennium Development Goals. It implies that achieving the MDG target through additional health aid alone would require a roughly 15-fold increase in current levels of aid. Language: English Keywords: GLOBAL | RESEARCH REPORT | HISTORICAL REVIEW | HEALTH | ESTIMATION TECHNIQUES | FOREIGN AID | INFANT MORTALITY | GOALS | GOVERNMENT FINANCING | RESOURCE ALLOCATION | PROGRAM EFFECTIVENESS | Research Methodology | Financial Activities | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Planning | Organization and Administration | Program Evaluation | Programs Document Number: 342295 |
| 14. Peer Reviewed Title: Comparison of HIV prevalence estimates from sentinel surveillance and a national population-based survey in Uganda, 2004-2005. Author: Musinguzi J; Kirungi W; Opio A; Montana L; Mishra V; Madraa E; Biryahwaho B; Mermin J; Bunnell R; Cross A; Hladik W; McFarland W; Stoneburner R Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):78-84. Abstract: OBJECTIVE: HIV programs in generalized epidemics have traditionally relied on antenatal clinic (ANC) sentinel surveillance data to guide prevention and to model epidemic trends. ANC data, however, come from a subset of the population, and their representativeness of the population has been debated. METHODS: Data from a national population-based Uganda HIV/AIDS Sero-Behavioral Survey (UHSBS) were compared with those from ANC sentinel surveillance. Using geographic information system, UHSBS clusters within a 30 km radius of the ANC sites were mapped. Estimates of HIV prevalence from ANC surveillance were compared with those from UHSBS. RESULTS: The ANC-based HIV prevalence, 6.0% [confidence interval (CI) 5.5% to 6.5%], was similar to that from UHSBS, 5.9% (CI 5.4% to 6.4%). The ANC-based estimate correlated with that of UHSBS catchment area women who were pregnant and those who had given birth in the 2 years preceding the survey. ANC data overestimated prevalence in the 15-year to 19-year age group, were similar to UHSBS for ages 20-29 years, and underestimated prevalence in older respondents. ANC data underestimated HIV prevalence among women (6.0% vs. 7.4%; CI 6.6% to 8.2%) and urban women (7.6% vs. 12.7%) but was similar for rural women (5.3% vs. 4.9%). CONCLUSIONS: ANC-based surveillance remains an important tool for monitoring HIV/AIDS programs. ANC and UHSBS data were similar overall and for 15-year to 29-year olds, women who were pregnant, and women who had a birth in the 2 years before the survey. ANC estimates were lower in those > or = 30 years and in urban areas. Periodic serosurveys to adjust ANC-based estimates are needed. Language: English Keywords: UGANDA | RESEARCH REPORT | ESTIMATION TECHNIQUES | COMPARATIVE STUDIES | HEALTH SURVEYS | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | MONITORING | BIAS | HIV TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Health | Viral Diseases | Diseases | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Evaluation | Error Sources | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 342359 |
| 15. Peer Reviewed Title: Advances in development reverse fertility declines. Author: Myrskyla M; Kohler HP; Billari FC Source: Nature. 2009 Aug 6;460(7256):741-3. Abstract: During the twentieth century, the global population has gone through unprecedented increases in economic and social development that coincided with substantial declines in human fertility and population growth rates. The negative association of fertility with economic and social development has therefore become one of the most solidly established and generally accepted empirical regularities in the social sciences. As a result of this close connection between development and fertility decline, more than half of the global population now lives in regions with below-replacement fertility (less than 2.1 children per woman). In many highly developed countries, the trend towards low fertility has also been deemed irreversible. Rapid population ageing, and in some cases the prospect of significant population decline, have therefore become a central socioeconomic concern and policy challenge. Here we show, using new cross-sectional and longitudinal analyses of the total fertility rate and the human development index (HDI), a fundamental change in the well-established negative relationship between fertility and development as the global population entered the twenty-first century. Although development continues to promote fertility decline at low and medium HDI levels, our analyses show that at advanced HDI levels, further development can reverse the declining trend in fertility. The previously negative development-fertility relationship has become J-shaped, with the HDI being positively associated with fertility among highly developed countries. This reversal of fertility decline as a result of continued economic and social development has the potential to slow the rates of population ageing, thereby ameliorating the social and economic problems that have been associated with the emergence and persistence of very low fertility. Language: English Keywords: GLOBAL | RESEARCH REPORT | LONGITUDINAL STUDIES | ESTIMATION TECHNIQUES | SOCIAL DEVELOPMENT | ECONOMIC DEVELOPMENT | FERTILITY DECLINE | BELOW REPLACEMENT FERTILITY | TOTAL FERTILITY RATE | DEMOGRAPHIC AGING | POPULATION REPLACEMENT | INTERNATIONAL MIGRATION | Studies | Research Methodology | Economic Factors | Fertility Changes | Fertility | Population Dynamics | Demographic Factors | Population | Population Decrease | Fertility Rate | Birth Rate | Fertility Measurements | Migration Document Number: 342781 |
| 16. Peer Reviewed Title: Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. Author: Park BJ; Wannemuehler KA; Marston BJ; Govender N; Pappas PG; Chiller TM Source: AIDS. 2009 Feb 20;23(4):525-30. Abstract: OBJECTIVE: Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. In order to help develop global strategies and priorities for prevention and treatment, it is important to estimate the burden of cryptococcal meningitis. DESIGN: Global burden of disease estimation using published studies. METHODS: We used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 United Nations Programme on HIV/AIDS HIV population estimate for each region to estimate cryptococcal meningitis cases. To estimate deaths, we assumed a 9% 3-month case-fatality rate among high-income regions, a 55% rate among low-income and middle-income regions, and a 70% rate in sub-Saharan Africa, based on studies published in these areas and expert opinion. RESULTS: Published incidence ranged from 0.04 to 12% per year among persons with HIV. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases; range, 144 000-1.3 million). Median incidence was lowest in Western and Central Europe and Oceania (Language: English Keywords: GLOBAL | AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | CROSS-CULTURAL COMPARISONS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | CENTRAL NERVOUS SYSTEM EFFECTS | MENINGITIS | COMPLICATIONS | HUMAN GEOGRAPHY | DEATH RATE | ECONOMIC DEVELOPMENT | Africa | Developing Countries | Research Methodology | Comparative Studies | Studies | HIV Infections | Viral Diseases | Diseases | Measurement | Central Nervous System | Physiology | Biology | Geography | Social Sciences | Science | Sociocultural Factors | Mortality | Population Dynamics | Demographic Factors | Population | Economic Factors Document Number: 341165 |
| 17. Peer Reviewed Title: Trends in three decades of HIV/AIDS epidemic in Thailand by nonparametric backcalculation method. Author: Punyacharoensin N; Viwatwongkasem C Source: AIDS. 2009 Jun 1;23(9):1143-52. Abstract: OBJECTIVES: To reconstruct the past HIV incidence and prevalence in Thailand from 1980 to 2008 and predict the country's AIDS incidence from 2009 to 2011. METHODS: Nonparametric backcalculation was adopted utilizing 100 quarterly observed new AIDS counts excluding pediatric cases. The accuracy of data was enhanced through a series of data adjustments using the weight method to account for several surveillance reporting issues. The mixture of time-dependent distributions allowed the effects of age at seroconversion and antiretroviral therapy to be incorporated simultaneously. Sensitivity analyses were conducted to assess model variations that were subject to major uncertainties. Future AIDS incidence was projected for various predetermined HIV incidence patterns. RESULTS: HIV incidence in Thailand reached its peak in 1992 with approximately 115,000 cases. A steep decline thereafter discontinued in 1997 and was followed by another strike of 42,000 cases in 1999. The second surge, which happened concurrently with the major economic crisis, brought on 60,000 new infections. As of December 2008, more than 1 million individuals had been infected and around 430,000 adults were living with HIV corresponding to a prevalence rate of 1.2%. The incidence rate had become less than 0.1% since 2002. The backcalculated estimates were dominated by postulated median AIDS progression time and adjustments to surveillance data. CONCLUSION: Our analysis indicated that, thus far, the 1990s was the most severe era of HIV/AIDS epidemic in Thailand with two HIV incidence peaks. A drop in new infections led to a decrease in recent AIDS incidence, and this tendency is likely to remain unchanged until 2011, if not further. Language: English Keywords: THAILAND | RESEARCH REPORT | HISTORICAL REVIEW | ESTIMATION TECHNIQUES | DATA ADJUSTMENT | AIDS | HIV INFECTIONS | EPIDEMICS | INCIDENCE | PREVALENCE | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Viral Diseases | Diseases | Measurement Document Number: 342452 |
| 18. Peer Reviewed Title: Increase in clinical prevalence of AIDS implies increase in unsafe medical injections. Author: Reid S Source: International Journal of STD and AIDS. 2009 May;20(5):295-9. Abstract: A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12-17%, and up to 34-47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | ESTIMATION TECHNIQUES | ADULTS | WHO | HIV INFECTIONS | PREVALENCE | HIV TRANSMISSION | NEEDLE PIERCING | NEEDLE SHARING | SAFETY | SYRINGE | Africa | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Viral Diseases | Diseases | Measurement | Risk Behavior | Behavior | Public Health | Health | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 341816 |
| 19. Peer Reviewed Title: Implications of the HIV testing protocol for refusal bias in seroprevalence surveys. Author: Reniers G; Araya T; Berhane Y; Davey G; Sanders EJ Source: BMC Public Health. 2009 May 28;9(1):163. Abstract: ABSTRACT: BACKGROUND: HIV serosurveys have become important sources of HIV prevalence estimates, but these estimates may be biased because of refusals and other forms of non-response. We investigate the effect of the post-test counseling study protocol on bias due to the refusal to be tested. METHODS: Data come from a nine-month prospective study of hospital admissions in Addis Ababa during which patients were approached for an HIV test. Patients had the choice between three consent levels: testing and post-test counseling (including the return of HIV test results), testing without post-test counseling, and total refusal. For all patients, information was collected on basic sociodemographic background characteristics as well as admission diagnosis. The three consent levels are used to mimic refusal bias in serosurveys with different post-test counseling study protocols. We first investigate the covariates of consent for testing. Second, we quantify refusal bias in HIV prevalence estimates using Heckman regression models that account for sample selection. RESULTS: Refusal to be tested positively correlates with admission diagnosis (and thus HIV status), but the magnitude of refusal bias in HIV prevalence surveys depends on the study protocol. Bias is larger when post-test counseling and the return of HIV test results is a prerequisite of study participation (compared to a protocol where test results are not returned to study participants, or, where there is an explicit provision for respondents to forego post-test counseling). We also find that consent for testing increased following the introduction of antiretroviral therapy in Ethiopia. Other covariates of refusal are age (non-linear effect), gender (higher refusal rates in men), marital status (lowest refusal rates in singles), educational status (refusal rate increases with educational attainment), and counselor. CONCLUSIONS: The protocol for post-test counseling and the return of HIV test results to study participants is an important consideration in HIV prevalence surveys that wish to minimize refusal bias. The availability of ART is likely to reduce refusal rates. Language: English Keywords: ETHIOPIA | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | ESTIMATION TECHNIQUES | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | HIV TESTING | BIAS | COUNSELING | VOLUNTARY COUNSELING AND TESTING | INFORMED CONSENT | ANTIRETROVIRAL THERAPY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Error Sources | Clinic Activities | Program Activities | Programs | Organization and Administration | HIV Document Number: 341483 |
| 20. Peer Reviewed Title: Trends in age at first sex in Uganda: Evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai. Author: Slaymaker E; Bwanika JB; Kasamba I; Lutalo T; Maher D; Todd J Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i12-i19. Abstract: This study sought to derive the best possible estimates of trends in age at first sex (AFS) among successive cohorts of Ugandan men and women based on all the data available from the Demographic and Health Surveys (DHS) and cohort studies in Masaka and Rakai districts. The authors analyzed the datasets from the DHS, Masaka cohort, and Rakai cohort separately. Survival analysis methods were used to estimate median AFS for men and women born in the 1950s–1980s and to compute hazard ratios for first sex, comparing later cohorts with earlier cohorts. The DHS and Masaka data showed an increase in age at first sex (AFS) in women in the more recent birth cohorts compared with those born before 1970, but this was less apparent in the Rakai data. Successive male cohorts in Masaka appeared first to have an increased AFS which subsequently decreased, a trend that was also apparent (but not significant) in the DHS data. Younger men in Rakai had an earlier AFS than those born before 1980. Women in Uganda who were born after 1970 have, on average, had sex at a later age than those born earlier. For men, AFS has not changed consistently over the period in question. Differences between Masaka and Rakai may reflect socioeconomic differences. Most of the change in AFS occurred too late to have contributed to the initial decline in the incidence of HIV. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | COHORT ANALYSIS | ESTIMATION TECHNIQUES | LONGITUDINAL STUDIES | POPULATION | AGE FACTORS | FIRST INTERCOURSE | SEX FACTORS | SOCIOECONOMIC FACTORS | HIV INFECTIONS | INCIDENCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population Characteristics | Sex Behavior | Behavior | Economic Factors | Viral Diseases | Diseases | Measurement Document Number: 340102 |
| 21. Peer Reviewed Title: Estimating incidence of HIV infection in Uganda [letter] Author: Westerhaus M Source: JAMA. Journal of the American Medical Association. 2009 Jan 14;301(2):160; author reply 160-1. Abstract: To the Editor: The study by Dr Mermin and colleagues provided data on recent HIV infection in Uganda by using theBED capture enzyme immunosorbent assay as a proxy for HIV incidence. It demonstrated that the weighted incidence of HIV infection in the region of north central Uganda was 4.7 per 100 person-years, more than double any other part of the country. Although only given brief mention in the discussion, this finding is extremely interesting and worth further attention because, as the authors note, north central Uganda (defined as the districts of Gulu, Kitgum, and Pader) has experienced war since 1986, unlike other parts of the country. The relationship between war and HIV transmission is disputed because certain conflict settings have appeared protective, 2 likely through isolation of the population, whereas in other settings war appears to increase risk of HIV infection. The lack of clarity regarding HIV transmission in conflict settings has been particularly true in north central Uganda. Data from the study by Mermin et al were collected between August 2004 and January 2005, a period of time in which active conflict still affected north central Uganda. Unfortunately, the article's results do not present a more detailed stratification of the particular sampling locations of the household surveys (eg, whether residing in an internally displaced people's camp, district of sampling, sex, education, wealth index by location). It is not clear if data were collected evenly across north central Uganda or if the authors were limited in their data collection by war activity. Provision of more detailed information about the sampling locations for north central Uganda, if available, would offer a more useful interpretation of the geographic differences in the patterns of incident HIV infection observed in the study and further insight about the relationship between war and HIV transmission. (full text) Language: English Keywords: UGANDA | CRITIQUE | INCIDENCE | HIV INFECTIONS | ESTIMATION TECHNIQUES | HIV TESTING | LABORATORY PROCEDURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 329781 |
| 22. Peer Reviewed Title: Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: A meta-analysis. Author: Cross Continents Collaboration for Kids (3Cs4kids) Analysis and Writing Committee Source: AIDS. 2008 Jan 2;22(1):97-105. Abstract: The objectives were to evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). Methods: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers,the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | METHODOLOGICAL STUDIES | ESTIMATION TECHNIQUES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EVALUATION INDEXES | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | GROWTH | RISK ASSESSMENT | LABORATORY EXAMINATIONS AND DIAGNOSES | HEMOGLOBIN LEVEL | HIV INFECTIONS | Research Methodology | Studies | Data Analysis | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Mortality | Population Dynamics | Child Development | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Physiology Document Number: 322744 |
| 23. Title: Potential market for CycleBeads: a basic model for estimating demand. Author: Georgetown University. Institute for Reproductive Health Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008. [13] p. (USAID Cooperative Agreement No. GPO-A-00-07-0003-00) Abstract: The purpose of this tool kit is to provide programs with guidelines for establishing an initial supply of CycleBeads in their country or region. CycleBeads are a string of teardrop-shaped, colored beads that represent each day of a woman's menstrual cycle. They help a women know if she is on a day when pregnancy is likely or on a day when pregnancy is very unlikely. CycleBeads are based on the Standard Days Method (SDM) of family planning. This model is a tool to help program managers use generally available statistics and data to define the potential market for CycleBeads in their area. It is intended to help guide estimations for overall CycleBeads demand in a country for which there is no or little historical data on CycleBeads use. (Excerpts) Language: English Keywords: GLOBAL | TEACHING MATERIALS | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | MENSTRUAL CYCLE | RHYTHM METHOD, CALENDAR | NEEDS | AWARENESS | IEC | FAMILY PLANNING, TRADITIONAL METHODS | Research Methodology | Theoretical Models | Menstruation | Reproduction | Family Planning, Behavioral Methods | Family Planning | Economic Factors | Knowledge | Sociocultural Factors | Program Activities | Programs | Organization and Administration Document Number: 331671 |
| 24. Peer Reviewed Title: Bayesian melding for estimating uncertainty in national HIV prevalence estimates. Author: Alkema L; Raftery AE; Brown T Source: Sexually Transmitted Infections. 2008 Aug;84 Suppl 1:i11-i16. Abstract: OBJECTIVE: To construct confidence intervals for HIV prevalence in countries with generalised epidemics. METHODS: In the Bayesian melding approach, a sample of country-specific epidemic curves describing HIV prevalence over time is derived based on time series of antenatal clinic prevalence data and general information on the parameters that describe the HIV epidemic. The prevalence trends at antenatal clinics are calibrated to population-based HIV prevalence estimates from national surveys. For countries without population based estimates, a general calibration method is developed. Based on the sample of calibrated epidemic curves, we derive annual 95% confidence intervals for HIV prevalence. The curve that best represents the data at antenatal clinics and population-based surveys, as well as general information about the epidemic, is chosen to represent the best estimates and predictions. RESULTS: We present results for urban areas in Haiti and Namibia to illustrate the estimates and confidenceintervals that are derived with the methodology. Language: English Keywords: NAMIBIA | HAITI | RESEARCH REPORT | HIV INFECTIONS | PREVALENCE | ESTIMATION TECHNIQUES | DATA COLLECTION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Caribbean | Americas | Viral Diseases | Diseases | Measurement | Research Methodology Document Number: 328285 |
| 25. Peer Reviewed Title: Estimating the relative success of local authorities at labour-market integration of immigrants. Author: Andersen SH; Heinesen E Source: European Journal of Population. 2008 Mar;24(1):59-86. Abstract: We propose a method for estimating indicators of the success of local authorities at integrating immigrants in the labour-market. The proportion of time in employment of individuals is used to measure labour-market integration, and we correct for differences in characteristics of immigrants and local labour markets using a two-limit Tobit model. This method is applied to a large administrative micro dataset which contains information on all immigrants in Denmark. We compare the estimated indicators of integration to corresponding uncorrected measures, and conclude that the corrections have a significant effect on the ranking of local authorities. (author's) Language: English Keywords: DENMARK | RESEARCH REPORT | ESTIMATION TECHNIQUES | IMMIGRANTS | GOVERNMENT | LABOR FORCE | EMPLOYMENT STATUS | SETTLEMENT AND RESETTLEMENT | ACCULTURATION | Developed Countries | Europe, Northern | Europe | Research Methodology | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Political Factors | Sociocultural Factors | Human Resources | Economic Factors | Socioeconomic Status | Socioeconomic Factors | Social Change Document Number: 325285 |
| 26. Peer Reviewed Title: Costs and benefits of HAART for patients with HIV in a public hospital in Mexico. Author: Aracena-Genao B; Navarro JO; Lamadrid-Figueroa H; Forsythe S; Trejo-Valdivia B Source: AIDS. 2008 Jul;22 Suppl 1:S141-8. Abstract: BACKGROUND: The Mexican government is currently implementing strategies to improve and expand comprehensive treatment for people living with HIV. Limited data, however, are available on the benefits obtained and costs incurred by these strategies. OBJECTIVE: To estimate the effects of highly active antiretroviral therapy (HAART) on a cohort of people living with HIV and to estimate the cost of extending patients' lives. METHODS: A survival analysis was used to follow a dynamic cohort of 797 people receiving AIDS treatment in Mexico from 1982 to 2006. The Kaplan-Meier method was applied to estimate the probability of survival for different lengths of time starting on the date of diagnosis. The Cox's proportional hazards regression model was used to assess differences in AIDS mortality by antiretroviral therapy regimen, age and sex. RESULTS: The probability of survival after diagnosis without antiretroviral therapy (ART) was approximately 0.73 (95% CI 0.69-0.77) after the first year, 0.36 (95% CI 0.32-0.40) at 5 years, 0.28 (95% CI 0.24-0.33) at the tenth year, 0.26 (95% CI 0.21-0.31) at the fifteenth year and 0.22 (95% CI 0.14-0.30) thereafter. The results showed a longer life expectancy when patients took HAART (as opposed to monotherapy or dual therapy) from the beginning of their treatment. Results from the Cox model showed that those who started and continued on HAART were 7.1 (P < 0.01) times more likely to survive than those who received no treatment. Extending the length of life beyond 15 years after the initial diagnosis represents an accumulated cost of more than US$280,000.00 per individual. Language: English Keywords: MEXICO | RESEARCH REPORT | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | COST BENEFIT ANALYSIS | HIV INFECTIONS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | HOSPITALS | PERSONS LIVING WITH HIV/AIDS | LENGTH OF LIFE | ESTIMATION TECHNIQUES | North America | Americas | Developing Countries | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Health Facilities | Persons Living With HIV/AIDS | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 328247 |
| 27. Title: Trends in HIV incidence in India from 2000 to 2007 [letter] Author: Arora P; Kumar R; Bhattacharya M; Nagelkerke NJ; Jha P Source: Lancet. 2008 Jul 26;372(9635):289-90. Abstract: India's HIV epidemic is of global interest. 2 years ago, we showed that HIV prevalence in young women declined by about a third between 2000 and 2004 in the southern states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu. HIV prevalence at young ages (15-24 years) is a useful proxy for trends in HIV incidence. We now present trends up to 2007. Among 423,842 women aged 15-24 years tested nationally at antenatal clinics, prevalence declined by 54% (95% CI -45 to -63; p<0.0001) between 2000 and 2007 in south India, and there was no significant change in north India (3%, -47 to 53; p=0.73) where HIV is less prevalent. Declines in south India were similar if we analysed individual age-groups, if we excluded Tamil Nadu, or restricted the analyses to each individual state or to the sites tested continuously for at least 4 years. Women who use antenatal clinics differ from those who do not in education, residence, and migration, but these demographic factors remained similar from year to year. More research is needed to understand why incidence has fallen in south India. The most probable reason is reduced contacts with female sex work by the husbands of tested women or increased condom use in sex work. Although useful for estimating trends in HIV incidence, data from antenatal clinics cannot estimate community prevalence reliably. The National Family Health Survey of 2005-06 (NFHS-3) yielded lower HIV prevalence nationally in adults (0.28%, 95% CI 0.25-0.31 at ages 15-49 years) than seen among women at antenatal clinics in our study (0.60%, 0.57-0.63 at ages 15-49 years). A study in one district suggested that women with HIV were over-represented in public antenatal clinics, but we found that HIV infection was associated with lower use of public antenatal clinics within the NHFS-3. Among 8743 eligible women, survival analyses with Cox's regression of time since last antenatal clinic use yielded a hazard ratio for HIV of 0.44 (0.22-0.90; p=0.02), after adjustment for age and sampling unit. The halving of new infections in south India and the lack of demonstrable increases in the north would, at first glance, seem to be consistent with India's downward revision of HIV prevalence in 2006 from 5.1 million to 2.5 million (range 2.0-3.1 million). However, the revised prevalence estimates are based largely on "hybrid" analyses that combine antenatal clinic and NFHS-3 data, whereas earlier estimates were based on antenatal clinic data. The NFHS-3 has biases also, including the under-representation of high-risk groups. In conclusion, although the estimation of HIV trends is reasonably robust, we caution that prevalence estimates remain uncertain. Reliable estimation of prevalence requires combining various sources of data, including information on AIDS mortality. (full-text) Language: English Keywords: INDIA | CRITIQUE | HIV INFECTIONS | PREVALENCE | EPIDEMIOLOGY | RELIABILITY | BIAS | ESTIMATION TECHNIQUES | Developing Countries | Asia, Southern | Asia | Viral Diseases | Diseases | Measurement | Research Methodology | Public Health | Health | Error Sources Document Number: 328267 |
| 28. Peer Reviewed Title: Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa. Author: Auvert B; Marseille E; Korenromp EL; Lloyd-Smith J; Sitta R Source: PLoS One. 2008 Aug 6;3(8):e2679. Abstract: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95%PI: 726 to 1 245). The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | THEORETICAL MODELS | MALE CIRCUMCISION | HIV PREVENTION | INTERVENTIONS | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | ESTIMATION TECHNIQUES | PRIVATE SECTOR | PUBLIC SECTOR | PROGRAM SUSTAINABILITY | Africa | Developing Countries | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Evaluation Indexes | Macroeconomic Factors | Economic Factors Document Number: 328126 |
| 29. Peer Reviewed Title: Systematic review of orogenital HIV-1 transmission probabilities. Author: Baggaley RF; White RG; Boily MC Source: International Journal of Epidemiology. 2008 Dec;37(6):1255-1265. Abstract: Background: The objective was to assess the risk of HIV transmission from orogenital intercourse (OI). Methods: Systematic review of the literature on HIV-1 infectiousness through OI conducted according to MOOSE guidelines for reviews of observational studies. The PubMed database and bibliographies of relevant articles were searched to July 2007. Results: Of the titles, 56 214 were searched from which 10 potentially appropriate studies were identified; two additional studies were identified through bibliographies and one through discussion with experts. There were 10 included studies, providing estimates of transmission probabilities per-partner (n=5), incidence per-partner (n=3), per-study participant (n=3, following initially seronegative individuals whose partners are of unknown serostatus) and per-act (n=3). Only four of 10 studies reported non-zero estimates: two per-partner estimates (20%, 95% CI: 6-51, n=10 and a modelbased estimate, 1%, range 0.85-2.3%), one per-study participant estimate (0.37%, 95% CI: 0.10-1.34%) and one per-act estimate (0.04%, 95% CI: 0.01-0.17%). Upper bounds for the 95% CI for zero estimates tended to be relatively large due to the small study sample sizes: 9.0, 12.1 and 2.8% for per-partner; 4.7, 9.6 and 1.8 per 100 person-years for incidence per-partner; 4.4% per-study participant and 0.45 and 0.02% for per-act. Given the small number of studies, a meta-analysis was not considered appropriate. Conclusions: There are currently insufficient data to estimate precisely the risk from OI exposure. The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates. Language: English Keywords: UNITED KINGDOM | LITERATURE REVIEW | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | SEXUAL PARTNERS | PERSONS LIVING WITH HIV/AIDS | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | ORAL SEX | HIV TRANSMISSION | RISK ASSESSMENT | PREVALENCE | PROBABILITY | Developed Countries | Europe, Western | Europe | Research Methodology | Sex Behavior | Behavior | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Theoretical Models | Evaluation | Measurement | Statistical Studies | Studies Document Number: 328776 |
| 30. Peer Reviewed Title: Spread pattern of the first dengue epidemics in the City of Salvador, Brazil. Author: Barreto FR; Teixeira MG; Costa MD; Carvalho MS; Barreto ML Source: BMC Public Health. 2008 Feb 7;8:51. Abstract: The explosive epidemics of dengue that have been occurring in various countries have stimulated investigation into new approaches to improve understanding of the problem and to develop new strategies for controlling the disease. The objective of this study was to evaluate the characteristics of diffusion of the first dengue epidemic that occurred in the city of Salvador in 1995. The epidemiological charts and records of notified cases of dengue in Salvador in 1995 constituted the source of data. The cases of the disease were georeferenced according to census areas (spatial units) and epidemiological weeks (temporal unit). Kernel density estimation was used to identify the pattern of spatial diffusion using the R-Project computer software program. Of the 2,006 census areas in the city, 1,400 (70%) registered cases of dengue in 1995 and the spatial distribution of these records revealed that by the end of 1995 practically the entire city had been affected by the virus, with the largest concentrationof cases occurring in the western region, composed of census areas with a high population density and predominantly horizontal residences compared to the eastern region of the city, where there is a predominance of vertical residential buildings. The pattern found in this study shows the characteristics of the classic process of spreading by contagion that is common to most infectious diseases. It was possible to identify the epicenter of the epidemic from which centrifugal waves of the disease emanated. Our results suggest that, if a more agile control instrument existed that would be capable of rapidly reducing the vector population within a few days or of raising the group immunity of the population by means of a vaccine, it would theoretically be possible to adopt control actions around the epicenter of the epidemic and consequently reduce the incidence of the disease in the city. This finding emphasizes the need for further research to improve the technology available for the prevention of this disease.(author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CENSUS METHODS | EVALUATION RESEARCH | ESTIMATION TECHNIQUES | URBAN POPULATION | DENGUE | HUMAN GEOGRAPHY | EPIDEMICS | PREVALENCE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Census | Population Statistics | Evaluation Methodology | Evaluation | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Geography | Social Sciences | Science | Sociocultural Factors | Measurement Document Number: 324429 |
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