The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds

Abstract

Background: The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival.

Methods: The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates.

Results: Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs.

Conclusions: The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners.

Figure 1. Inputs, outputs and process of the demographic and AIDS modules in Spectrum.

Figure 2. Net survival curves, for grouped studies from East Africa (population cohorts), South Africa (miners occupational cohort) and the fitted Weibull model.

Figure 3. Probability of death among 36 615 adult ART-treated patients in 17 cohorts in Africa, Asia and South America (courtesy of ART-LINC Collaboration).