An epidemiological modelling study to estimate the composition of HIV-positive populations including migrants from endemic settings

TY - JOUR

T1 - An epidemiological modelling study to estimate the composition of HIV-positive populations including migrants from endemic settings

AU - Nakagawa, F

AU - Delpech, V

AU - Albert, J

AU - Alioum, A

AU - Bezemer, D

AU - Cortina-Borja, M

AU - Brown, A E

AU - Cambiano, V

AU - Campbell, C

AU - Costagliola, D

AU - de Luca, A

AU - Kouyos, R

AU - Lodwick, R

AU - Lundgren, J D

AU - Pantazis, N

AU - Smith, C

AU - Supervie, V

AU - Tookey, P

AU - Touloumi, G

AU - Yin, Z

AU - van Sighem, A

AU - Phillips, A N

AU - Writing Group on HIV Epidemiologic Estimates in Countries With Migrant Populations From High Prevalence Areas

PY - 2017/1/28

Y1 - 2017/1/28

N2 - Objective: Migrants account for a significant number of people living with HIV in Europe, and it is important to fully consider this population in national estimates. Using a novel approach with the UK as an example, we present key public health measures of the HIV epidemic, taking into account both in-country infections and infections likely to have been acquired abroad. Design: Mathematical model calibrated to extensive data sources. Methods: An individual-based stochastic simulation model is used to calibrate to routinely collected surveillance data in the UK. Data on number of new HIV diagnoses, number of deaths, CD4+ cell count at diagnosis, as well as time of arrival into the UK for migrants and the annual number of people receiving care were used. Results: An estimated 106 400 (90% plausibility range: 88 700-124 600) people were living with HIV in the UK in 2013. Twenty-three percent of these people, 24 600 (15 000-36 200) were estimated to be undiagnosed; this number has remained stable over the last decade. An estimated 32% of the total undiagnosed population had CD4+ cell count less than 350 cells/ml in 2013. Twenty-five and 23% of black African men and women heterosexuals living with HIV were undiagnosed respectively. Conclusion: We have shown a working example to characterize the HIV population in a European context which incorporates migrants from countries with generalized epidemics. Despite all aspects of HIV care being free and widely available to anyone in need in the UK, there is still a substantial number of people who are not yet diagnosed and thus not in care.

AB - Objective: Migrants account for a significant number of people living with HIV in Europe, and it is important to fully consider this population in national estimates. Using a novel approach with the UK as an example, we present key public health measures of the HIV epidemic, taking into account both in-country infections and infections likely to have been acquired abroad. Design: Mathematical model calibrated to extensive data sources. Methods: An individual-based stochastic simulation model is used to calibrate to routinely collected surveillance data in the UK. Data on number of new HIV diagnoses, number of deaths, CD4+ cell count at diagnosis, as well as time of arrival into the UK for migrants and the annual number of people receiving care were used. Results: An estimated 106 400 (90% plausibility range: 88 700-124 600) people were living with HIV in the UK in 2013. Twenty-three percent of these people, 24 600 (15 000-36 200) were estimated to be undiagnosed; this number has remained stable over the last decade. An estimated 32% of the total undiagnosed population had CD4+ cell count less than 350 cells/ml in 2013. Twenty-five and 23% of black African men and women heterosexuals living with HIV were undiagnosed respectively. Conclusion: We have shown a working example to characterize the HIV population in a European context which incorporates migrants from countries with generalized epidemics. Despite all aspects of HIV care being free and widely available to anyone in need in the UK, there is still a substantial number of people who are not yet diagnosed and thus not in care.

KW - Endemic Diseases

KW - Epidemiologic Methods

KW - Female

KW - HIV Infections/epidemiology

KW - Humans

KW - Male

KW - Models, Theoretical

KW - Transients and Migrants

KW - United Kingdom

U2 - 10.1097/QAD.0000000000001329

DO - 10.1097/QAD.0000000000001329

M3 - Journal article

C2 - 27831947

SN - 1350-2840

VL - 31

SP - 417

EP - 425

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 3

ER -