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

Michael A. Cork, Nathaniel J. Henry, Stefanie Watson, Andrew J. Croneberger, Mathew Baumann, Ian D. Letourneau, Mingyou Yang, Audrey L. Serfes, Jaffar Abbas, Nooshin Abbasi, Hedayat Abbastabar, Lucas G. Abreu, Eman Abu-Gharbieh, Basavaprabhu Achappa, Maryam Adabi, Tadele G. Adal, Adeyinka E. Adegbosin, Victor Adekanmbi, Olatunji O. Adetokunboh, Marcela Agudelo-BoteroBright O. Ahinkorah, Keivan Ahmadi, Muktar B. Ahmed, Robert K. Alhassan, Vahid Alipour, Amir Almasi-Hashiani, Nelson Alvis-Guzman, Robert Ancuceanu, Tudorel Andrei, Davood Anvari, Muhammad Aqeel, Jalal Arabloo, Olatunde Aremu, Malke Asaad, Desta D. Atnafu, Alok Atreya, Beatriz Paulina Ayala Quintanilla, Samad Azari, Darshan B B, Atif A. Baig, Maciej Banach, Simachew A. Bante, Miguel A. Barboza, Sanjay Basu, Neeraj Bedi, Diana Bejarano Ramirez, Isabela M. Bensenor, Fentahun Y. Beyene, Yihienew M. Bezabih, Akshaya S. Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Zulfiqar A. Bhutta, Ali Bijani, Sait M. Birlik, Zebenay W. Bitew, Somayeh Bohlouli, Archith Boloor, Andre R. Brunoni, Zahid A. Butt, Rosario Cárdenas, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos Castañeda-Orjuela, Jaykaran Charan, Souranshu Chatterjee, Vijay Kumar Chattu, Soosanna Kumary Chattu, Mohiuddin Ahsanul Kabir Chowdhury, Devasahayam J. Christopher, Dinh Toi Chu, Aubrey J. Cook, Natalie M. Cormier, Saad M A Dahlawi, Farah Daoud, Claudio A Dávila-Cervantes, Nicole Davis Weaver, Fernando P De la Hoz, Feleke M. Demeke, Edgar Denova-Gutiérrez, Kebede Deribe, Keshab Deuba, Samath D. Dharmaratne, Govinda P. Dhungana, Daniel Diaz, Shirin Djalalinia, Andre R. Duraes, Arielle W. Eagan, Lucas Earl, Andem Effiong, Maysaa El Sayed Zaki, Maha El Tantawi, Rajesh Elayedath, Shaimaa I El-Jaafary, Emerito Jose A Faraon, Andre Faro, Nazir Fattahi, Nelsensius K. Fauk, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A. Foigt, Masoud Foroutan, Takeshi Fukumoto, Mohamed M. Gad, Tesfay B B Gebremariam, Ketema B. Gebremedhin, Gebreamlak G. Gebremeskel, Hailay A. Gesesew, Keyghobad Ghadiri, Ahmad Ghashghaee, Syed Amir Gilani, Mahaveer Golechha, Ugo Gori, Alessandra C. Goulart, Bárbara N.G. Goulart, Harish C. Gugnani, Mark D C Guimaraes, Rafael A Guimarães, Yuming Guo, Rahul Gupta, Emily Haeuser, Mohammad Rifat Haider, Teklehaimanot G. Haile, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Asif Hanif, Arief Hargono, Ninuk Hariyani, Soheil Hassanipour, Hadi Hassankhani, Khezar Hayat, Claudiu Herteliu, Hung Chak Ho, Ramesh Holla, Mehdi Hosseinzadeh, Mowafa Househ, Bing Fang Hwang, Charles U. Ibeneme, Segun E. Ibitoye, Olayinka S. Ilesanmi, Milena D. Ilic, Irena M. Ilic, Usman Iqbal, Deepa Jahagirdar, Vardhmaan Jain, Mihajlo Jakovljevic, Ravi P. Jha, Kimberly B. Johnson, Nitin Joseph, Farahnaz Joukar, Leila R. Kalankesh, Rohollah Kalhor, Tanuj Kanchan, Behzad Karami Matin, André Karch, Salah Eddin Karimi, Getinet Kassahun, Gbenga A. Kayode, Ali Kazemi Karyani, Maryam Keramati, Nauman Khalid, Ejaz A. Khan, Gulfaraz Khan, Md Nuruzzaman N Khan, Khaled Khatab, Neda Kianipour, Yun Jin Kim, Sezer Kisa, Adnan Kisa, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Ricardo S. Kuchenbecker, Vaman Kulkarni, Nithin Kumar, Manasi Kumar, Om P. Kurmi, Dian Kusuma, Carlo La Vecchia, Dharmesh K. Lal, Iván Landires, Savita Lasrado, Paul H. Lee, Kate E. LeGrand, Bingyu Li, Shanshan Li, Xuefeng Liu, Hawraz I M. Amin, Daiane B. Machado, Deepak Madi, Carlos Magis-Rodriguez, Deborah C. Malta, Mohammad Ali Mansournia, Md Dilshad Manzar, Carlos A Marrugo Arnedo, Francisco R Martins-Melo, Seyedeh Zahra Masoumi, Benjamin K. Mayala, Carlo E Medina-Solís, Ziad A. Memish, Walter Mendoza, Ritesh G. Menezes, Tomislav Mestrovic, Andreea Mirica, Babak Moazen, Yousef Mohammad, Naser Mohammad Gholi Mezerji, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Shafiu Mohammed, Ali H. Mokdad, Mohammad Ali Moni, Masoud Moradi, Yousef Moradi, Rahmatollah Moradzadeh, Paula Moraga, Amin Mousavi Khaneghah, Ghulam Mustafa, Lillian Mwanri, Ravishankar Nagaraja, Ahamarshan J. Nagarajan, Mukhammad David Naimzada, Bruno R. Nascimento, Dr M. Naveed, Vinod C. Nayak, Javad Nazari, Hadush Negash, Ionut Negoi, Samata Nepal, Georges Nguefack-Tsague, Cuong T. Nguyen, Huong L T Nguyen, Rajan Nikbakhsh, Jean Jacques Noubiap, Virginia Nunez-Samudio, Bogdan Oancea, Felix A. Ogbo, Andrew T. Olagunju, Nikita Otstavnov, Mahesh P A, Jagadish Rao Padubidri, Seithikurippu R Pandi-Perumal, Ana M Pardo-Montaño, Urvish K. Patel, Shrikant Pawar, Emmanuel K. Peprah, Alexandre Pereira, Samantha Perkins, Julia M. Pescarini, Khem N. Pokhrel, Maarten J. Postma, Faheem H. Pottoo, Sergio I. Prada, Liliana Preotescu, Dimas R A Pribadi, Amir Radfar, Fakher Rahim, Mohammad Hifz Ur Rahman, Amir Masoud Rahmani, Kiana Ramezanzadeh, Juwel Rana, Chhabi L. Ranabhat, Sowmya J. Rao, Priya Rathi, Salman Rawaf, David L. Rawaf, Reza Rawassizadeh, Vishnu Renjith, Nima Rezaei, Aziz Rezapour, Ana Isabel Ribeiro, Leonardo Roever, Enrico Rubagotti, Susan F. Rumisha, Godfrey M. Rwegerera, Rajesh Sagar, S. Mohammad Sajadi, Marwa R. Salem, Abdallah M. Samy, Rodrigo Sarmiento-Suárez, Brijesh Sathian, Lauren E. Schaeffer, Ione J C Schneider, Abdul Aziz Seidu, Feng Sha, Masood A. Shaikh, Kiomars Sharafi, Aziz Sheikh, Kenji Shibuya, Jae Il Shin, Diego A S Silva, Jasvinder A. Singh, Valentin Y. Skryabin, Anna A. Skryabina, Amber Sligar, Amin Soheili, Krista M. Steuben, Mu’awiyyah B. Sufiyan, Eyayou G. Tadesse, Ayenew K T Tesema, Fisaha H. Tesfay, Rekha Thapar, Robert L. Thompson, Marcos Tovani-Palone, Bach X. Tran, Gebiyaw W. Tsegaye, Chukwuma D. Umeokonkwo, Bhaskaran Unnikrishnan, Yasser Vasseghian, Francesco S. Violante, Bay Vo, Giang T. Vu, Yasir Waheed, Yuan Pang Wang, Yanzhong Wang, Paul Ward, Fissaha T. Welay, Ronny Westerman, Nuwan D. Wickramasinghe, Sanni Yaya, Paul Yip, Naohiro Yonemoto, Chuanhua Yu, Deniz Yuce, Hasan Yusefzadeh, Maryam Zamanian, Mikhail S. Zastrozhin, Zhi Jiang Zhang, Yunquan Zhang, Arash Ziapour, Simon I. Hay, Laura Dwyer-Lindgren

Research output: Contribution to journalArticlepeer-review

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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.
Original languageEnglish (US)
JournalBMC Medicine
Volume19
Issue number1
DOIs
StatePublished - Jan 8 2021

ASJC Scopus subject areas

  • Medicine(all)

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