Mahy Mary, Penazzato Martina, Ciaranello Andrea, Mofenson Lynne, Yianoutsos Constantin T, Davies Mary-Ann, Stover John
aJoint UN Programme on HIV/AIDSbHIV Department, World Health Organization, Geneva, SwitzerlandcMassachusetts General Hospital, Boston, MassachusettsdElizabeth Glaser Pediatric AIDS Foundation, Washington, District of ColumbiaeIndiana University, Indianapolis, Indiana, USAfUniversity of Cape Town, Cape Town, South AfricagAvenir Health, Glastonbury, Connecticut, USA.
AIDS. 2017 Apr;31 Suppl 1(Suppl 1):S13-S22. doi: 10.1097/QAD.0000000000001306.
Estimated numbers of children living with HIV determine programmatic and treatment needs. We explain the changes made to the UNAIDS estimates between 2015 and 2016, and describe the challenges around these estimates.
Estimates of children newly infected, living with HIV, and dying of AIDS are developed by country teams using Spectrum software. Spectrum files are available for 160 countries, which represent 98% of the global population. In 2016, the methods were updated to reflect the latest evidence on mother-to-child HIV transmission and improved assumptions on the age children initiate antiretroviral therapy. We report updated results using the 2016 model and validate these estimates against mother-to-child transmission rates and HIV prevalence from population-based surveys for the survey year.
The revised 2016 model estimates 27% fewer children living with HIV in 2014 than the 2015 model, primarily due to changes in the probability of mother-to-child transmission among women with incident HIV during pregnancy. The revised estimates were consistent with population-based surveys of HIV transmission and HIV prevalence among children aged 5-9 years, but were lower than surveys among children aged 10-14 years.
The revised 2016 model is an improvement on previous models. Paediatric HIV models will continue to evolve as further improvements are made to the assumptions. Commodities forecasting and programme planning rely on these estimates, and increasing accuracy will be critical to enable effective scale-up and optimal use of resources. Efforts are needed to improve empirical measures of HIV prevalence, incidence, and mortality among children.
感染艾滋病毒儿童的估计数量决定了规划和治疗需求。我们解释了2015年至2016年期间联合国艾滋病规划署估计数的变化，并描述了这些估计数面临的挑战。
各国团队使用Spectrum软件对新感染艾滋病毒、感染艾滋病毒存活以及死于艾滋病的儿童进行估计。有160个国家可获取Spectrum文件，这些国家占全球人口的98%。2016年，方法进行了更新，以反映母婴艾滋病毒传播的最新证据，并改进了儿童开始接受抗逆转录病毒治疗年龄的假设。我们使用2016年模型报告更新后的结果，并根据调查年份基于人群的调查得出的母婴传播率和艾滋病毒流行率对这些估计数进行验证。
2016年修订后的模型估计，2014年感染艾滋病毒的儿童比2015年模型少27%，主要原因是孕期感染艾滋病毒的妇女母婴传播概率发生了变化。修订后的估计数与基于人群的5至9岁儿童艾滋病毒传播和艾滋病毒流行率调查结果一致，但低于10至14岁儿童的调查结果。
2016年修订后的模型比以前的模型有所改进。随着假设的进一步完善，儿科艾滋病毒模型将继续发展。商品预测和项目规划依赖于这些估计数，提高准确性对于有效扩大规模和优化资源利用至关重要。需要努力改进儿童艾滋病毒流行率、发病率和死亡率的实证测量方法。
