Repository of Research and Investigative Information

Repository of Research and Investigative Information

Dezful University of Medical Sciences

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

(2021) Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. Bmc Medicine. p. 25. ISSN 1741-7015

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Abstract

BackgroundHuman 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.MethodsWe 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.ResultsAll 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 45years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur 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.

Item Type: Article
Keywords: HIV AIDS Latin America HIV mortality Vital registration Small area estimation Mapping Spatial statistics antiretroviral therapy global burden low-income trends hiv/aids sex health brazil death tuberculosis General & Internal Medicine
Subjects: QW Microbiology and Immunology > QW 501-949 Immunology
Divisions: Education Vice-Chancellor Department > Faculty of Medicine > Department of Basic Science > Department of Microbiology
Page Range: p. 25
Journal or Publication Title: Bmc Medicine
Journal Index: ISI
Volume: 19
Number: 1
Identification Number: https://doi.org/10.1186/s12916-020-01876-4
ISSN: 1741-7015
Depositing User: مهندس مهدی شریفی
URI: http://eprints.dums.ac.ir/id/eprint/742

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