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

Cork, MA, Henry, NJ, Watson, S, Croneberger, AJ, Baumann, M, Letourneau, ID, Yang, M, Serfes, AL, Tesfay, Fisaha and et al 2021, Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems, BMC Medicine, vol. 19, pp. 1-25, doi: 10.1186/s12916-020-01876-4.

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Title Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
Author(s) Cork, MA
Henry, NJ
Watson, S
Croneberger, AJ
Baumann, M
Letourneau, ID
Yang, M
Serfes, AL
Tesfay, FisahaORCID iD for Tesfay, Fisaha orcid.org/0000-0003-0399-1711
et al
Journal name BMC Medicine
Volume number 19
Article ID 4
Start page 1
End page 25
Total pages 25
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2021
ISSN 1741-7015
1741-7015
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
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
Local Burden of Disease HIV Collaborators
Summary 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.
Language eng
DOI 10.1186/s12916-020-01876-4
Indigenous content off
Field of Research 11 Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30149428

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.