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dc.contributor.authorEaton, Jeffrey W
dc.contributor.authorDwyer-Lindgren, Laura
dc.contributor.authorGutreuter, Steve
dc.contributor.authorO'Driscoll, Megan
dc.contributor.authorStevens, Oliver
dc.contributor.authorBajaj, Sumali
dc.contributor.authorAshton, Rob
dc.contributor.authorHill, Alexandra
dc.contributor.authorRussell, Emma
dc.contributor.authorEsra, Rachel
dc.contributor.authorDolan, Nicolas
dc.contributor.authorAnifowoshe, Yusuf O
dc.contributor.authorWoodbridge, Mark
dc.contributor.authorFellows, Ian
dc.contributor.authorGlaubius, Robert
dc.contributor.authorHaeuser, Emily
dc.contributor.authorOkonek, Taylor
dc.contributor.authorStover, John
dc.contributor.authorThomas, Matthew L
dc.contributor.authorWakefield, Jon
dc.contributor.authorWolock, Timothy M
dc.contributor.authorBerry, Jonathan
dc.contributor.authorSabala, Tomasz
dc.contributor.authorHeard, Nathan
dc.contributor.authorDelgado, Stephen
dc.contributor.authorJahn, Andreas
dc.contributor.authorKalua, Thokozani
dc.contributor.authorChimpandule, Tiwonge
dc.contributor.authorAuld, Andrew
dc.contributor.authorKim, Evelyn
dc.contributor.authorPayne, Danielle
dc.contributor.authorJohnson, Leigh F
dc.contributor.authorFitzJohn, Richard G
dc.contributor.authorWanyeki, Ian
dc.contributor.authorMahy, Mary I
dc.contributor.authorShiraishi, Ray W
dc.date.accessioned2021-10-18T23:30:35Z
dc.date.available2021-10-18T23:30:35Z
dc.date.issued2021-09
dc.identifier.issn1758-2652
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/329591
dc.description.abstractINTRODUCTION: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. METHODS: Small-area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016-2018. RESULTS: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty-eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. CONCLUSIONS: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data.
dc.format.mediumPrint
dc.languageeng
dc.publisherWiley
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.titleNaomi: a new modelling tool for estimating HIV epidemic indicators at the district level in sub-Saharan Africa.
dc.typeArticle
prism.publicationDate2021
prism.publicationNameJ Int AIDS Soc
prism.startingPagee25788
prism.volume24 Suppl 5
dc.identifier.doi10.17863/CAM.77040
dcterms.dateAccepted2021-07-19
rioxxterms.versionofrecord10.1002/jia2.25788
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2021-09
dc.contributor.orcidEaton, Jeffrey W [0000-0001-7728-728X]
dc.contributor.orcidStevens, Oliver [0000-0001-6842-9434]
dc.contributor.orcidGlaubius, Robert [0000-0002-4936-0264]
dc.contributor.orcidStover, John [0000-0001-7236-1989]
dc.contributor.orcidWolock, Timothy M [0000-0001-5898-1014]
dc.contributor.orcidJohnson, Leigh F [0000-0002-2717-011X]
dc.contributor.orcidMahy, Mary I [0000-0001-6023-3023]
dc.identifier.eissn1758-2652
rioxxterms.typeJournal Article/Review
cam.issuedOnline2021-09-21


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International