The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds
- 1Futures Institute, Glastonbury, Connecticut, USA
- 2US Census Bureau, Washington, USA
- 3London School of Hygiene and Tropical Medicine, London, UK
- 4Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- 5Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen, Bordeaux, France
- 6UNICEF, New York City, USA
- Mr John Stover, Futures Institute, Glastonbury, Connecticut, USA;
- Accepted 22 May 2008
Background: The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival.
Methods: The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates.
Results: Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs.
Conclusions: The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners.
Funding: The Spectrum software, manuals and training materials have been developed with funding from USAID. UNAIDS supported some modifications to add additional indicators of interest to national programmes.
Competing interests: None.
Contributors: All authors reviewed the final manuscript. JS was primarily responsible for the introduction and the sections on uncertainty, strengths and weaknesses. Each of the other authors contributed a section of the paper: PJ on non-AIDS mortality by single age, BZ on progression from infection to death without treatment, MZ on time to eligibility for treatment, FD on effects of ART on survival and RE on mother-to-child transmission.