Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania;
Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania; Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Glob Health Action. 2014 Jan 16;7:21783. doi: 10.3402/gha.v7.21783. eCollection 2014.
Spectrum epidemiological models are used by UNAIDS to provide global, regional and national HIV estimates and projections, which are then used for evidence-based health planning for HIV services. However, there are no validations of the Spectrum model against empirical serological and mortality data from populations in sub-Saharan Africa.
Serologic, demographic and verbal autopsy data have been regularly collected among over 30,000 residents in north-western Tanzania since 1994. Five-year age-specific mortality rates (ASMRs) per 1,000 person years and the probability of dying between 15 and 60 years of age (45Q15,) were calculated and compared with the Spectrum model outputs. Mortality trends by HIV status are shown for periods before the introduction of antiretroviral therapy (1994-1999, 2000-2005) and the first 5 years afterwards (2005-2009).
Among 30-34 year olds of both sexes, observed ASMRs per 1,000 person years were 13.33 (95% CI: 10.75-16.52) in the period 1994-1999, 11.03 (95% CI: 8.84-13.77) in 2000-2004, and 6.22 (95% CI; 4.75-8.15) in 2005-2009. Among the same age group, the ASMRs estimated by the Spectrum model were 10.55, 11.13 and 8.15 for the periods 1994-1999, 2000-2004 and 2005-2009, respectively. The cohort data, for both sexes combined, showed that the 45Q15 declined from 39% (95% CI: 27-55%) in 1994 to 22% (95% CI: 17-29%) in 2009, whereas the Spectrum model predicted a decline from 43% in 1994 to 37% in 2009.
From 1994 to 2009, the observed decrease in ASMRs was steeper in younger age groups than that predicted by the Spectrum model, perhaps because the Spectrum model under-estimated the ASMRs in 30-34 year olds in 1994-99. However, the Spectrum model predicted greater 45Q15 mortality than observed in the cohort,although the reasons for this over-estimate are unclear [corrected].
UNAIDS 使用谱流行病学模型提供全球、区域和国家艾滋病毒估计数和预测数，然后据此为艾滋病毒服务进行循证卫生规划。但是，尚未根据撒哈拉以南非洲人群的血清学和死亡率经验数据对 Spectrum 模型进行验证。
自 1994 年以来，在坦桑尼亚西北部定期收集了超过 30,000 名居民的血清学、人口统计学和尸检数据。计算了每 1,000 人年的特定年龄死亡率（ASMR）和 15 至 60 岁之间死亡的概率（45Q15），并将其与 Spectrum 模型的输出进行了比较。显示了按艾滋病毒状况分列的死亡率趋势，包括在引入抗逆转录病毒疗法之前的时期（1994-1999 年，2000-2005 年）和之后的头 5 年（2005-2009 年）。
在男女 30-34 岁年龄组中，1994-1999 年期间每 1,000 人年的 ASMR 为 13.33（95%CI：10.75-16.52），2000-2004 年为 11.03（95%CI：8.84-13.77），2005-2009 年为 6.22（95%CI；4.75-8.15）。在同一年龄组中，Spectrum 模型分别估计了 1994-1999 年、2000-2004 年和 2005-2009 年期间的 ASMR 为 10.55、11.13 和 8.15。男女合并的队列数据显示，45Q15 从 1994 年的 39%（95%CI：27-55%）下降到 2009 年的 22%（95%CI：17-29%），而 Spectrum 模型预测从 1994 年的 43%下降到 2009 年的 37%。
1994 年至 2009 年间，年轻年龄组的 ASMR 观察到的下降幅度比 Spectrum 模型预测的要陡峭，这可能是因为 Spectrum 模型低估了 1994-99 年间 30-34 岁年龄组的 ASMR。然而，Spectrum 模型预测的 45Q15 死亡率高于队列观察值，尽管原因尚不清楚[更正]。
