Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
Cork, M. A., Henry, N. J., Watson, S. , Croneberger, A. J., Baumann, M., Letourneau, I. D., Yang, M., Serfes, A. L., Abbas, J., Abbasi, N., Abbastabar, H., Abreu, L. G., Abu-Gharbieh, E., Achappa, B., Adabi, M., Adal, T. G., Adegbosin, A. E., Adekanmbi, V., Adetokunboh, O. O., Agudelo-Botero, M., Ahinkorah, B. O., Ahmadi, K., Ahmed, M. B., Alhassan, R. K., Alipour, V., Almasi-Hashiani, A., Alvis-Guzman, N., Ancuceanu, R., Andrei, T., Anvari, D., Aqeel, M., Arabloo, J., Aremu, O., Asaad, M., Atnafu, D. D., Atreya, A., Quintanilla, B.P. A., Azari, S., Darshan, B. B., Baig, A. A., Banach, M., Bante, S. A., Barboza, M. A., Basu, S., Bedi, N., Bejarano Ramirez, D. F., Bensenor, I. M., Beyene, F. Y., Bezabih, Y. M., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Birlik, S. M., Bitew, Z. W., Bohlouli, S., Boloor, A., Brunoni, A. R., Butt, Z. A., Cardenas, R., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Charan, J., Chatterjee, S., Chattu, V. K., Chattu, S. K., Chowdhury, M. A. K., Christopher, D. J., Chu, D-T., Cook, A. J., Cormier, N. M., Dahlawi, S. M. A., Daoud, F., Davila Cervantes, C. A., Weaver, N. D., De la Hoz, F. P., Demeke, F. M., Denova-Gutierrez, E., Deribe, K., Deuba, K., Dharmaratne, S. D., Dhungana, G. P., Diaz, D., Djalalinia, S., Duraes, A. R., Eagan, A. W., Earl, L., Effiong, A., Zaki, M. E. S., El Tantawi, M., Elayedath, R., El-Jaafary, S. I., Faraon, E. J. A., Faro, A., Fattahi, N., Fauk, N. K., Fernandes, E., Filip, I., Fischer, F., Foigt, N. A., Foroutan, M., Fukumoto, T., Gad, M. M., Gebremariam, T. B. B., Gebremedhin, K. B., Gebremeskel, G. G., Gesesew, H. A., Ghadiri, K., Ghashghaee, A., Gilani, S. A., Golechha, M., Gori, U., Goulart, A. C., Goulart, B. N. G., Gugnani, H. C., Guimaraes, M. D. C., Guimaraes, R. A., Guo, Y., Gupta, R., Haeuser, E., Haider, M. R., Haile, T. G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hanif, A., Hargono, A., Hariyani, N., Hassanipour, S., Hassankhani, H., Hayat, K., Herteliu, C., Ho, H. C., Holla, R., Hosseinzadeh, M., Househ, M., Hwang, B. F., Ibeneme, C. U., Ibitoye, S. E., Ilesanmi, O. S., Ilic, M.D., Ilic, I. M., Iqbal, U., Jahagirdar, D., Jain, V., Jakovljevic, M., Jha, R. P., Johnson, K. B., Joseph, N., Joukar, F., Kalankesh, L. R., Kalhor, R., Kanchan, T., Matin, B. K., Karch, A., Karimi, S. E., Kassahun, G., Kayode, G. A., Karyani, A. K., Keramati, M., Khalid, N., Khan, E. A., Khan, G., Khan, M. N. N., Khatab, K., Kianipour, N., Kim, Y. J., Kisa, S., Kisa, A., Kosen, S., Laxminarayana, S. L. K., Koyanagi, A., Krishan, K., Defo, B. K., Kuchenbecker, R. S., Kulkarni, V., Kumar, N., Kumar, M., Kurmi, Om P, Kusuma, D. 
ORCID: 0000-0002-1909-9341, La Vecchia, C., Lal, D. K., Landires, I., Lasrado, S., Lee, P. H., LeGrand, K. E., Li, B., Li, S., Liu, X., Amin, H. I. M., Machado, D. B., Madi, D., Magis-Rodriguez, C., Malta, D. C., Mansournia, M. A., Manzar, M. D., Marrugo Arnedo, C. A., Martins-Melo, F. R., Masoumi, S. Z., Mayala, B. K., Medina-Solis, C. E., Memish, Z. A., Mendoza, W., Menezes, R. G., Mestrovic, T., Mirica, A., Moazen, B., Mohammad, Y., Mezerji, N. M. G., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mokdad, A. H., Moni, M. A., Moradi, M., Moradi, Y., Moradzadeh, R., Moraga, P., Khaneghah, A. M., Mustafa, G., Mwanri, L., Nagaraja, R., Nagarajan, A. J., Naimzada, M. D., Nascimento, B. R., Naveed, M., Nayak, V. C., Nazari, J., Negash, H., Negoi, I., Nepal, S., Nguefack-Tsague, G., Nguyen, C. T., Nguyen, H. L. T., Nikbakhsh, R., Noubiap, J. J., Nunez-Samudio, V., Oancea, B., Ogbo, F.A., Olagunju, A. T., Otstavnov, N., Mahesh, P. A., Padubidri, J. R., Perumal, S. R. P., Pardo-Montano, A. M., Patel, U. K., Pawar, S., Peprah, E. K., Pereira, A., Perkins, S., Pescarini, J. M., Pokhrel, K. N., Postma, M. J., Pottoo, F. H., Prada, S. I., Preotescu, L., Pribadi, D. R. A., Radfar, A., Rahim, F., Rahman, M. H. U., Rahmani, A. M., Ramezanzadeh, K., Rana, J., Ranabhat, C. L., Rao, S. J., Rathi, P., Rawaf, S., Rawaf, D. L., Rawassizadeh, R., Renjith, V., Rezaei, N., Rezapour, A., Ribeiro, A. I., Roever, L., Rubagotti, E., Rumisha, S. F., Rwegerera, G. M., Sagar, R.., Sajadi, S. M., Salem, M. R., Samy, A. M., Sarmiento-Suarez, R., Sathian, B., Schaeffer, L. E., Schneider, I. J. C., Seidu, A-A., Sha, F., Shaikh, M. A., Sharafi, K., Sheikh, A., Shibuya, K., Shin, J. I. l., Silva, D. A. S., Singh, J. A., Skryabin, V. Y., Skryabina, A. A., Sligar, A., Soheili, A., Steuben, K. M., Sufiyan, M. B., Tadesse, E. G., Tesema, A. K. T., Tesfay, F. H., Thapar, R., Thompson, R. L., Tovani-Palone, M. R., Tran, B. X., Tsegaye, G. W., Umeokonkwo, C. D., Unnikrishnan, B., Vasseghian, Y., Violante, F. S., Vo, B., Vu, G. T., Waheed, Y., Wang, Y-P., Wang, Y., Ward, P., Welay, F. T., Westerman, R., Wickramasinghe, N. D., Yaya, S., Yip, P., Yonemoto, N., Yu, C., Yuce, D., Yusefzadeh, H., Zamanian, M., Zastrozhin, M. S., Zhang, Z-J., Zhang, Y., Ziapour, A., Hay, S.n I., Dwyer-Lindgren, L. & Local Burden of Disease HIV Collaborators (2021).
Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems.
BMC Medicine, 19(1),
article number 4.
doi: 10.1186/s12916-020-01876-4
Abstract
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.
| Publication Type: | Article |
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| Additional Information: | This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
| Publisher Keywords: | HIV/AIDS, Latin America, HIV mortality, Vital registration, Small area estimation, Mapping, Spatial statistics |
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
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