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Trop Med Int Health. 2012 Aug;17(8):e3-14. doi: 10.1111/j.1365-3156.2011.02943.x.

Using age-specific mortality of HIV infected persons to predict anti-retroviral treatment need: a comparative analysis of data from five African population-based cohort studies.

Author information

  • 1London School of Hygiene and Tropical Medicine, London, UK. basia.zaba@lshtm.ac.uk

Abstract

OBJECTIVES:

To present a simple method for estimating population-level anti-retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence.

METHODS:

A new approach to estimating ART need is developed based on calculating age-specific proportions of HIV-infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV-infected adults in the pre-treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3 years, conditional 3-year survival probabilities were computed to represent proportions needing ART. The build-up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3 years of expected death was represented by annually extending the conditional survival range.

RESULTS:

The Weibull model: survival probability in the infected state from age 15 = exp(-0.0073 × (age - 15)(1.69)) fitted the pooled age-specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 20-24 to 32% at age 40-44 and 42% at age 60-64. Overall need in the treatment of naïve population was 24%, doubling within 5 years in a programme continually recruiting patients entering the high-risk period for dying.

CONCLUSION:

A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV-infected people.

© 2012 Blackwell Publishing Ltd.

PMID:
22943377
[PubMed - indexed for MEDLINE]
PMCID:
PMC3443363
Free PMC Article
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