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Quaife M, Medley GF, Jit M, Drake T, Asaria M, van Baal P, Baltussen R, Bollinger L, Bozzani F, Brady O, Broekhuizen H, Chalkidou K, Chi YL, Dowdy DW, Griffin S, Haghparast-Bidgoli H, Hallett T, Hauck K, Hollingsworth TD, McQuaid CF, Menzies NA, Merritt MW, Mirelman A, Morton A, Ruiz FJ, Siapka M, Skordis J, Tediosi F, Walker P, White RG, Winskill P, Vassall A, Gomez GB. Considering equity in priority setting using transmission models: Recommendations and data needs. Epidemics 2022; 41:100648. [PMID: 36343495 PMCID: PMC9623400 DOI: 10.1016/j.epidem.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.
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Affiliation(s)
- M. Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - GF Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - M. Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - T. Drake
- Center for Global Development in Europe (CGD Europe), UK
| | - M. Asaria
- LSE Health, London School of Economics, UK
| | - P. van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - R. Baltussen
- Nijmegen International Center for Health Systems Research and Education, Radboudmc, the Netherlands
| | | | - F. Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - O. Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - H. Broekhuizen
- Centre for Space, Place, and Society, Wageningen University and Research, Netherlands
| | - K. Chalkidou
- International Decision Support Initiative, Imperial College London, UK
| | - Y.-L. Chi
- International Decision Support Initiative, Imperial College London, UK
| | - DW Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - S. Griffin
- Centre for Health Economics, University of York, UK
| | - H. Haghparast-Bidgoli
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - T. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - K. Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - TD Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | - CF McQuaid
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - NA Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - MW Merritt
- Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - A. Mirelman
- Centre for Health Economics, University of York, UK
| | - A. Morton
- Department of Management Science, University of Strathclyde, UK
| | - FJ Ruiz
- International Decision Support Initiative, Imperial College London, UK
| | - M. Siapka
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Impact Elipsis, Greece
| | - J. Skordis
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - F. Tediosi
- Swiss Tropical and Public Health Institute and Universität Basel, Switzerland
| | - P. Walker
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - RG White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - P. Winskill
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - A. Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Correspondence to: London School of Hygiene and Tropical Medicine, 15 – 17 Tavistock Place, London WC1H 9SH, UK
| | - GB Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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Meyersohn NM, Mayrhofer T, Corey KE, Bittner DO, Staziaki PV, Szilveszter B, Hallett T, Lu MT, Puchner SB, Simon TG, Foldyna B, Voora D, Ginsburg GS, Douglas PS, Hoffmann U, Ferencik M. Association of Hepatic Steatosis With Major Adverse Cardiovascular Events, Independent of Coronary Artery Disease. Clin Gastroenterol Hepatol 2021; 19:1480-1488.e14. [PMID: 32707340 PMCID: PMC7855524 DOI: 10.1016/j.cgh.2020.07.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Hepatic steatosis has been associated with increased risk of major adverse cardiovascular events (MACE) but it is not clear whether steatosis is independently associated with risk of MACE. We investigated whether steatosis is associated with risk of MACE independently of the presence and extent of baseline coronary artery disease, assessed by comprehensive contrast-enhanced computed tomography angiography (CTA). METHODS We conducted a nested cohort study of 3756 subjects (mean age, 60.6 years; 48.4% men) who underwent coronary CTA at 193 sites in North America, from July 2010 through September 2013, as part of the PROMISE study, which included noninvasive cardiovascular analyses of symptomatic outpatients without coronary artery disease. Independent core laboratory readers measured hepatic and splenic attenuation, using non-contrast computed tomography images to identify steatosis, and evaluated coronary plaques and stenosis in coronary CTA images. We collected data on participants' cardiovascular risk factors, presence of metabolic syndrome, and body mass index. The primary endpoint was an adjudicated composite of MACE (death, myocardial infarction, or unstable angina) during a median follow-up time of 25 months. RESULTS Among the 959 subjects who had steatosis (25.5% of the cohort), 42 had MACE (4.4%), whereas among the 2797 subjects without steatosis, 73 had MACE (2.6%) (hazard ratio [HR] for MACE in subjects with steatosis, 1.69; 95% CI, 1.16-2.48; P = .006 for MACE in subjects with vs without steatosis). This association remained after adjustment for atherosclerotic cardiovascular disease risk scores, significant stenosis, and metabolic syndrome (adjusted HR, 1.72; 95% CI, 1.16-2.54; P = .007) or obesity (adjusted HR, 1.75; 95% CI, 1.19-2.59; P = .005). Steatosis remained independently associated with MACE after adjustment for all CTA measures of plaques and stenosis. CONCLUSIONS Hepatic steatosis is associated with MACE independently of other cardiovascular risk factors or extent of coronary artery disease. Strategies to reduce steatosis might reduce risk of MACE. ClinicalTrials.gov no: NCT01174550.
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Affiliation(s)
- Nandini M. Meyersohn
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA,School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Kathleen E. Corey
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Daniel O. Bittner
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA,Friedrich-Alexander University Erlangen-Nürnberg, Department of Cardiology, University Hospital Erlangen, Germany
| | - Pedro V. Staziaki
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Balint Szilveszter
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Travis Hallett
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Stefan B. Puchner
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA,Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tracey G. Simon
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Deepak Voora
- Duke Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC
| | - Geoffrey S. Ginsburg
- Duke Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Udo Hoffmann
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA
| | - Maros Ferencik
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA,Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
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Meyersohn NM, Mayrhofer T, Ivanov A, Bittner DO, Staziaki PV, Szilveszter B, Hallett T, Lu ML, Puchner SB, Simon TG, Corey KE, Ginsburg GS, Douglas PS, Hoffmann U, Ferencik M. P6209Association of hepatic steatosis with adverse cardiovascular events: insights from the PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N M Meyersohn
- Massachusetts General Hospital, Boston, United States of America
| | - T Mayrhofer
- Massachusetts General Hospital, Boston, United States of America
| | - A Ivanov
- Massachusetts General Hospital, Boston, United States of America
| | - D O Bittner
- Massachusetts General Hospital, Boston, United States of America
| | - P V Staziaki
- Massachusetts General Hospital, Boston, United States of America
| | - B Szilveszter
- Massachusetts General Hospital, Boston, United States of America
| | - T Hallett
- Massachusetts General Hospital, Boston, United States of America
| | - M L Lu
- Massachusetts General Hospital, Boston, United States of America
| | - S B Puchner
- Massachusetts General Hospital, Boston, United States of America
| | - T G Simon
- Massachusetts General Hospital, Boston, United States of America
| | - K E Corey
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke University Medical Center, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
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Bittner D, Mayrhofer T, Budoff M, Szilveszter B, Hallett T, Ivanov A, Janjua S, Meyersohn N, Staziaki P, Achenbach S, Ferencik M, Douglas P, Hoffmann U, Lu M. 1184Prognostic value of coronary CT angiography beyond coronary artery calcium in stable chest pain: comparison between conventional stenosis severity and CAD-RADS stenosis categories in the PROMISE trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Bittner
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - T Mayrhofer
- Harvard Medical School, Boston, United States of America
| | - M Budoff
- University of California Los Angeles, Los Angeles, United States of America
| | - B Szilveszter
- Harvard Medical School, Boston, United States of America
| | - T Hallett
- Harvard Medical School, Boston, United States of America
| | - A Ivanov
- Harvard Medical School, Boston, United States of America
| | - S Janjua
- Harvard Medical School, Boston, United States of America
| | - N Meyersohn
- Harvard Medical School, Boston, United States of America
| | - P Staziaki
- Harvard Medical School, Boston, United States of America
| | - S Achenbach
- University of Erlangen-Nuremberg, Department of Cardiology, Erlangen, Germany
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
| | - P Douglas
- Duke Clinical Research Institute, Durham, United States of America
| | - U Hoffmann
- Harvard Medical School, Boston, United States of America
| | - M Lu
- Harvard Medical School, Boston, United States of America
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Borquez A, Cori A, Pufall E, Kasule J, Slaymaker E, Price A, Elmes J, Gregson S, Crampin M, Urassa M, Kagaayi J, Lutalo T, Hallett T. P16.11 Estimating the distribution of new hiv infections by key determinants in generalised epidemics of sub-saharan africa using a validated mathematical model. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bórquez A, Silva-Santisteban A, Guanira J, Salazar X, Caballero P, Nunes-Curto A, Motta A, Castillo R, Bracamonte P, Benites C, Minaya P, Hallett T, Cáceres C. O12.4 Impact and cost-effectiveness of hiv prevention interventions among transgender women sex-workers in lima, peru using mathematical modelling informed by stakeholder analysis and health system capacity evaluation. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Elmes J, Nhongo K, Hallett T, White P, Ward H, Garnett G, Nyamukapa C, Gregson S. P3.104 The Social Organisation of Sex Work in Rural Eastern Zimbabwe and Its Implications For HIV Infection. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Elmes J, Nhongo K, Hallett T, White P, Ward H, Garnett G, Nyamukapa C, Gregson S. O07.4 The Price of Sex: Insights into the Determinants of the Price of Commercial Sex Among Female Sex Workers in Rural Zimbabwe. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alsallaq R, Buttolph J, Cleland C, Hallett T, Kurth A. P3.384 Estimating the Impact of Combined Prevention Interventions Targeting 15–24 Years-Old Men and Women in Nyanza, Kenya. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alsallaq R, Baeten J, Hughes J, Abu-Raddad L, Celum C, Hallett T. O1-S06.04 Modelling the effectiveness of combination prevention from a house-to-house HIV testing platform in KwaZulu Natal, South Africa. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Elmes J, Nhongo K, Hallett T, White P, Mutsindiri R, Garnett G, Nyamukapa C, Gregson S. O1-S08.02 Who are the women at risk of HIV infection in rural Zimbabwe and how many are there? Insights into their characteristics, locations, and behaviours. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smit M, Smit C, Cremin I, Hallett T, de Wolf F, Garnett G. P3-S3.09 New drugs targeting toxicities have highest hope of impacting patient prognosis. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cremin I, Hallett T, Dybul M, Piot P, Garnett G. O1-S06.03 Pre-exposure prophylaxis for HIV prevention. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Eaton J, Takavarasha F, Gregson S, Hallett T, Mason P, Robertson L, Schumacher C, Nyamukapa C, Garnett G. O1-S04.01 Increasing adolescent HIV prevalence in Northeastern Zimbabwe: evidence of long-term survivors of mother to child transmission. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hewett P, Mensch B, Hallett T, Garnett G, Dzekedzeke K, Todd P. O2-S2.02 Sex with stitches, the resumption of sexual activity during the post-circumcision healing period in Zambia. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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White P, Birger R, Saunders J, Estcourt C, Hallett T, Caffrey O, Mercer C, Roberts T. P3-S5.02 Is urethral smear microscopy In asymptomatic men effective in reducing Major M genitalium infection sequelae in women? Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stover J, Johnson P, Hallett T, Marston M, Becquet R, Timaeus IM. The Spectrum projection package: improvements in estimating incidence by age and sex, mother-to-child transmission, HIV progression in children and double orphans. Sex Transm Infect 2011; 86 Suppl 2:ii16-21. [PMID: 21106510 PMCID: PMC3173821 DOI: 10.1136/sti.2010.044222] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The Spectrum program is used to estimate key HIV indicators from the trends in incidence and prevalence estimated by the Estimation and Projection Package or the Workbook. These indicators include the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, the number of adults and children needing treatment, the need for prevention of mother-to-child transmission and the impact of antiretroviral treatment on survival. The UNAIDS Reference Group on Estimates, Models and Projections regularly reviews new data and information needs, and recommends updates to the methodology and assumptions used in Spectrum. Methods The latest update to Spectrum was used in the 2009 round of global estimates. This update contains new procedures for estimating: the age and sex distribution of adult incidence, new child infections occurring around delivery or through breastfeeding, the survival of children by timing of infection and the number of double orphans.
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Affiliation(s)
- J Stover
- Futures Institute, 41A New London Turnpike, Glastonbury, CT 06033, USA.
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Cremin I, Mushati P, Hallett T, Mupambireyi Z, Nyamukapa C, Garnett GP, Gregson S. Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe. Sex Transm Infect 2009; 85 Suppl 1:i34-40. [PMID: 19307339 PMCID: PMC2654143 DOI: 10.1136/sti.2008.033431] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify reporting biases and to determine the influence of inconsistent reporting on observed trends in the timing of age at first sex and age at marriage. METHODS Longitudinal data from three rounds of a population-based cohort in eastern Zimbabwe were analysed. Reports of age at first sex and age at marriage from 6837 individuals attending multiple rounds were classified according to consistency. Survival analysis was used to identify trends in the timing of first sex and marriage. RESULTS In this population, women initiate sex and enter marriage at younger ages than men but spend much less time between first sex and marriage. Among those surveyed between 1998 and 2005, median ages at first sex and first marriage were 18.5 years and 21.4 years for men and 18.2 years and 18.5 years, respectively, for women aged 15-54 years. High levels of reports of both age at first sex and age at marriage among those attending multiple surveys were found to be unreliable. Excluding reports identified as unreliable from these analyses did not alter the observed trends in either age at first sex or age at marriage. Tracing birth cohorts as they aged revealed reporting biases, particularly among the youngest cohorts. Comparisons by birth cohorts, which span a period of >40 years, indicate that median age at first sex has remained constant over time for women but has declined gradually for men. CONCLUSIONS Although many reports of age at first sex and age at marriage were found to be unreliable, inclusion of such reports did not result in artificial generation or suppression of trends.
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Affiliation(s)
- I Cremin
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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Hallett T. the ANALYST'S column. Anal Chem 1957. [DOI: 10.1021/ac60129a772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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