Approaches to Developing National Estimates

UNAIDS Reference Group on Estimates, Models and

Projections

Approaches to Developing National Estimates

Estimate should be owned by the National AIDS Control Program

National consensus workshop• Involve key experts• Bring all expertise about surveillance

data• Improve surveillance system

Release of estimate can be advocacy opportunity

National Workshop

Surveillance methodology Surveillance data Discussion and agreement on

methodology Agreement on major trends Review of results How to use results Key dissemination messages Public seminar

Methodology Generalized epidemics

• Urban/rural• Province• Site specific with district mapping• Consider characteristics of sites

Concentrated epidemics• National or provincial• Risk groups to include• Estimation of risk group size

Range of estimates

Kaporo

Mbalachanda HC

St. John’s Hosp.

Rumphi DH

NkhataBay DH

St. Anne’s Hosp.Kamboni HC

Mchinji DH

Lilongwe CH

Ntcheu DH

Thonje HC

Kasina HC

Mangochi DH

Nsanje DH

Mianga HC

QECH

Gawanani HC

Milepa HC

Mulanje M. Hosp.

HIV Sentinel Sites

Urban

Semi-urban

Rural

HIV Sentinel Sites in Malawi

Region District Urban site Rural siteNorth Chitipa Kasoba/Kaporo Mbalachanda-Kaporo

Karonga Nkhata Bay Kasoba/KaporoRumphi Rumphi MbalachandaNkhata Bay Nkhata Bay Mbalachanda-KaporoMzimba Rumphi MbalachandaMzuzu City St. John's St. John'sLikoma Nkhata Bay-Kaporo Nkhata Bay-Kaporo

Central Kasungu Mchinji KamboniNkhotakota Nkhotakota KamboniNtchisi Thonje-Mchinji ThonjeDowa Mchinji ThonjeSalima Mchinji-Nkhotakota Nkhata Bay-KaporoLilongwe Lilongwe KasinaMchinji Mchinji KamboniDedza Ntcheu KasinaNtcheu Ntcheu Kasina

South Mangochi Mangochi GawananiMachinga Mangochi GawananiBalaka Mangochi-Ntcheu GawananiZomba Blantyre Gawanani-MilepaChiradzulu Mulanje MilepaBlantyre Blantyre Milepa-MiangaMwanza Mchinji GawananiThyolo Mulanje MiangaMulanje Mulanje MiangaPhalombe Milepa MilepaChikwawa Nsanje Milepa-MiangaNsanje Nsanje Milepa-Mianga

Agreement on Trends

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1990 1995 2000

Nyeri

Agreement on Trends

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1990 1995 2000

MeruNyeriThikaMaraguaNjambini

Is prevalence declining?

0

5

10

15

20

25

30

35

Phi=1.49; SSQ=0.013096 Data

Is prevalence declining?

0

5

10

15

20

25

30

35

1980 1983 1986 1989 1992 1995 1998 2001 2004 2007

Phi=1.49; SSQ=0.013096 PHI=100; SSQ=.013466 Data

New Sites

0%

5%

10%

15%

20%

25%

1990 1995 2000

Site ASite BSite CSite DSite ESite F

New Sites

0%

5%

10%

15%

20%

25%

1990 1995 2000

Site ASite BSite CSite DSite ESite FFit all

New Sites

0%

5%

10%

15%

20%

25%

1990 1995 2000

Site ASite BSite CSite DSite ESite FFit allFit old

New Sites

0%

5%

10%

15%

20%

25%

1990 1995 2000

Site ASite BSite CSite DSite ESite FFit allFit oldAdjusted