BACKGROUND: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. METHODS: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. RESULTS: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. CONCLUSIONS: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
BACKGROUND: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. METHODS: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. RESULTS: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries-apart from Ecuador-across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups-the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. CONCLUSIONS: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.
Entities:
Keywords:
HIV mortality; HIV/AIDS; Latin America; Mapping; Small area estimation; Spatial statistics; Vital registration
Authors: Eliane Rolim de Holanda; Marli Teresinha Gimeniz Galvão; Nathália Lima Pedrosa; Simone de Sousa Paiva; Rosa Lívia Freitas de Almeida Journal: Rev Lat Am Enfermagem Date: 2015-07-03
Authors: Laura Dwyer-Lindgren; Amelia Bertozzi-Villa; Rebecca W Stubbs; Chloe Morozoff; Michael J Kutz; Chantal Huynh; Ryan M Barber; Katya A Shackelford; Johan P Mackenbach; Frank J van Lenthe; Abraham D Flaxman; Mohsen Naghavi; Ali H Mokdad; Christopher J L Murray Journal: JAMA Date: 2016-12-13 Impact factor: 56.272
Authors: Gabriela Carriquiry; Valeria Fink; John Robert Koethe; Mark Joseph Giganti; Karu Jayathilake; Meridith Blevins; Pedro Cahn; Beatriz Grinsztejn; Marcelo Wolff; Jean William Pape; Denis Padgett; Juan Sierra Madero; Eduardo Gotuzzo; Catherine Carey McGowan; Bryan Earl Shepherd Journal: J Int AIDS Soc Date: 2015-07-10 Impact factor: 5.396
Authors: Giovanni Ravasi; Beatriz Grinsztejn; Ricardo Baruch; Juan Vicente Guanira; Ricardo Luque; Carlos F Cáceres; Massimo Ghidinelli Journal: J Int AIDS Soc Date: 2016-10-18 Impact factor: 5.396
Authors: Ligia Kerr; Carl Kendall; Mark Drew Crosland Guimarães; Rosa Salani Mota; Maria Amélia Veras; Inês Dourado; Ana Maria de Brito; Edgar Merchan-Hamann; Alexandre Kerr Pontes; Andréa Fachel Leal; Daniela Knauth; Ana Rita Coimbra Motta Castro; Raimunda Hermelinda Maia Macena; Luana Nepomuceno Costa Lima; Lisangela Cristina Oliveira; Maria do Socorro Cavalcantee; Adele Schwartz Benzaken; Gerson Pereira; Cristina Pimenta; Ana Roberta Pati Pascom; Ximena Pamela Diaz Bermudez; Regina Célia Moreira; Luis Fernando Macedo Brígido; Ana Cláudia Camillo; Willi McFarland; Lisa G Johnston Journal: Medicine (Baltimore) Date: 2018-05 Impact factor: 1.889
Authors: Mats Målqvist; Leif Eriksson; Thu Nga Nguyen; Linn Irene Fagerland; Phuong Hoa Dinh; Lars Wallin; Uwe Ewald; Lars-Ake Persson Journal: BMC Int Health Hum Rights Date: 2008-03-28
Authors: Laura Dwyer-Lindgren; Ellen R Squires; Stephanie Teeple; Gloria Ikilezi; D Allen Roberts; Danny V Colombara; Sarah Katherine Allen; Stanley M Kamande; Nicholas Graetz; Abraham D Flaxman; Charbel El Bcheraoui; Kristjana Asbjornsdottir; Gilbert Asiimwe; Ângelo Augusto; Orvalho Augusto; Baltazar Chilundo; Caroline De Schacht; Sarah Gimbel; Carol Kamya; Faith Namugaya; Felix Masiye; Cremildo Mauieia; Yodé Miangotar; Honoré Mimche; Acácio Sabonete; Haribondhu Sarma; Kenneth Sherr; Moses Simuyemba; Aaron Chisha Sinyangwe; Jasim Uddin; Bradley H Wagenaar; Stephen S Lim Journal: Popul Health Metr Date: 2018-08-13
Authors: Nelsensius Klau Fauk; Lillian Mwanri; Karen Hawke; Leila Mohammadi; Paul Russell Ward Journal: Int J Environ Res Public Health Date: 2022-05-30 Impact factor: 4.614