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

Cork, M.A. and Henry, N.J. and Watson, S. and Croneberger, A.J. and Baumann, M. and Letourneau, I.D. and Yang, M. and Serfes, A.L. and Abbas, J. and Abbasi, N. and Abbastabar, H. and Abreu, L.G. and Abu-Gharbieh, E. and Achappa, B. and Adabi, M. and Adal, T.G. and Adegbosin, A.E. and Adekanmbi, V. and Adetokunboh, O.O. and Agudelo-Botero, M. and Ahinkorah, B.O. and Ahmadi, K. and Ahmed, M.B. and Alhassan, R.K. and Alipour, V. and Almasi-Hashiani, A. and Alvis-Guzman, N. and Ancuceanu, R. and Andrei, T. and Anvari, D. and Aqeel, M. and Arabloo, J. and Aremu, O. and Asaad, M. and Atnafu, D.D. and Atreya, A. and Paulina Ayala Quintanilla, B. and Azari, S. and B B, D. and Baig, A.A. and Banach, M. and Bante, S.A. and Barboza, M.A. and Basu, S. and Bedi, N. and F Bejarano Ramirez, D. and Bensenor, I.M. and Beyene, F.Y. and Bezabih, Y.M. and Bhagavathula, A.S. and Bhardwaj, N. and Bhardwaj, P. and Bhattacharyya, K. and Bhutta, Z.A. and Bijani, A. and Birlik, S.M. and Bitew, Z.W. and Bohlouli, S. and Boloor, A. and Brunoni, A.R. and Butt, Z.A. and Cárdenas, R. and Carvalho, F. and Mauricio Castaldelli-Maia, J. and A Castañeda-Orjuela, C. and Charan, J. and Chatterjee, S. and Chattu, V.K. and Chattu, S.K. and Ahsanul Kabir Chowdhury, M. and Christopher, D.J. and Chu, D.-T. and Cook, A.J. and Cormier, N.M. and M A Dahlawi, S. and Daoud, F. and A Dávila-Cervantes, C. and Weaver, N.D. and P De la Hoz, F. and Demeke, F.M. and Denova-Gutiérrez, E. and Deribe, K. and Deuba, K. and Dharmaratne, S.D. and Dhungana, G.P. and Diaz, D. and Djalalinia, S. and Duraes, A.R. and Eagan, A.W. and Earl, L. and Effiong, A. and El Sayed Zaki, M. and Tantawi, M.E. and Elayedath, R. and I El-Jaafary, S. and Jose A Faraon, E. and Faro, A. and Fattahi, N. and Fauk, N.K. and Fernandes, E. and Filip, I. and Fischer, F. and Foigt, N.A. and Foroutan, M. and Fukumoto, T. and Gad, M.M. and B B Gebremariam, T. and Gebremedhin, K.B. and Gebremeskel, G.G. and Gesesew, H.A. and Ghadiri, K. and Ghashghaee, A. and Gilani, S.A. and Golechha, M. and Gori, U. and Goulart, A.C. and Goulart, B.N.G. and Gugnani, H.C. and D C Guimaraes, M. and A Guimarães, R. and Guo, Y. and Gupta, R. and Haeuser, E. and Haider, M.R. and Haile, T.G. and Haj-Mirzaian, A. and Haj-Mirzaian, A. and Hanif, A. and Hargono, A. and Hariyani, N. and Hassanipour, S. and Hassankhani, H. and Hayat, K. and Herteliu, C. and Ho, H.C. and Holla, R. and Hosseinzadeh, M. and Househ, M. and Hwang, B.-F. and Ibeneme, C.U. and Ibitoye, S.E. and Ilesanmi, O.S. and Ilic, M.D. and Ilic, I.M. and Iqbal, U. and Jahagirdar, D. and Jain, V. and Jakovljevic, M. and Jha, R.P. and Johnson, K.B. and Joseph, N. and Joukar, F. and Kalankesh, L.R. and Kalhor, R. and Kanchan, T. and Matin, B.K. and Karch, A. and Karimi, S.E. and Kassahun, G. and Kayode, G.A. and Karyani, A.K. and Keramati, M. and Khalid, N. and Khan, E.A. and Khan, G. and Nuruzzaman N Khan, M. and Khatab, K. and Kianipour, N. and Kim, Y.J. and Kisa, S. and Kisa, A. and Kosen, S. and Lakshmi Koulmane Laxminarayana, S. and Koyanagi, A. and Krishan, K. and Defo, B.K. and Kuchenbecker, R.S. and Kulkarni, V. and Kumar, N. and Kumar, M. and Kurmi, O.P. and Kusuma, D. and Vecchia, C.L. and Lal, D.K. and Landires, I. and Lasrado, S. and Lee, P.H. and LeGrand, K.E. and Li, B. and Li, S. and Liu, X. and I M. Amin, H. and Machado, D.B. and Madi, D. and Magis-Rodriguez, C. and Malta, D.C. and Mansournia, M.A. and Manzar, M.D. and A Marrugo Arnedo, C. and R Martins-Melo, F. and Masoumi, S.Z. and Mayala, B.K. and E Medina-Solís, C. and Memish, Z.A. and Mendoza, W. and Menezes, R.G. and Mestrovic, T. and Mirica, A. and Moazen, B. and Mohammad, Y. and Mohammad Gholi Mezerji, N. and Mohammadian-Hafshejani, A. and Mohammadpourhodki, R. and Mohammed, S. and Mokdad, A.H. and Moni, M.A. and Moradi, M. and Moradi, Y. and Moradzadeh, R. and Moraga, P. and Khaneghah, A.M. and Mustafa, G. and Mwanri, L. and Nagaraja, R. and Nagarajan, A.J. and Naimzada, M.D. and Nascimento, B.R. and Naveed, D.M. and Nayak, V.C. and Nazari, J. and Negash, H. and Negoi, I. and Nepal, S. and Nguefack-Tsague, G. and Nguyen, C.T. and L T Nguyen, H. and Nikbakhsh, R. and Noubiap, J.J. and Nunez-Samudio, V. and Oancea, B. and Ogbo, F.A. and Olagunju, A.T. and Otstavnov, N. and P A, M. and Padubidri, J.R. and R Pandi-Perumal, S. and M Pardo-Montaño, A. and Patel, U.K. and Pawar, S. and Peprah, E.K. and Pereira, A. and Perkins, S. and Pescarini, J.M. and Pokhrel, K.N. and Postma, M.J. and Pottoo, F.H. and Prada, S.I. and Preotescu, L. and R A Pribadi, D. and Radfar, A. and Rahim, F. and Hifz Ur Rahman, M. and Rahmani, A.M. and Ramezanzadeh, K. and Rana, J. and Ranabhat, C.L. and Rao, S.J. and Rathi, P. and Rawaf, S. and Rawaf, D.L. and Rawassizadeh, R. and Renjith, V. and Rezaei, N. and Rezapour, A. and Ribeiro, A.I. and Roever, L. and Rubagotti, E. and Rumisha, S.F. and Rwegerera, G.M. and Sagar, R. and Sajadi, S.M. and Salem, M.R. and Samy, A.M. and Sarmiento-Suárez, R. and Sathian, B. and Schaeffer, L.E. and J C Schneider, I. and Seidu, A.-A. and Sha, F. and Shaikh, M.A. and Sharafi, K. and Sheikh, A. and Shibuya, K. and Shin, J.I. and A S Silva, D. and Singh, J.A. and Skryabin, V.Y. and Skryabina, A.A. and Sligar, A. and Soheili, A. and Steuben, K.M. and Sufiyan, M.B. and Tadesse, E.G. and K T Tesema, A. and Tesfay, F.H. and Thapar, R. and Thompson, R.L. and R Tovani-Palone, M. and Tran, B.X. and Tsegaye, G.W. and Umeokonkwo, C.D. and Unnikrishnan, B. and Vasseghian, Y. and Violante, F.S. and Vo, B. and Vu, G.T. and Waheed, Y. and Wang, Y.-P. and Wang, Y. and Ward, P. and Welay, F.T. and Westerman, R. and Wickramasinghe, N.D. and Yaya, S. and Yip, P. and Yonemoto, N. and Yu, C. and Yuce, D. and Yusefzadeh, H. and Zamanian, M. and Zastrozhin, M.S. and Zhang, Z.-J. and Zhang, Y. and Ziapour, A. and Hay, S.I. and Dwyer-Lindgren, L. and of Disease HIV Collaborators, Local Burden (2021) Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Medicine, 19 (1).

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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. © 2021, The Author(s).

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