1. Spectrum 2007Overview and New Changes UNAIDS Reference Group on Estimates, Model and Projections 2007

2. Purpose • Determine the consequences of the prevalence estimates made with EPP or Workbook • New infections, HIV+ population, AIDS deaths • Need for treatment and effects of treatment • Orphans and vulnerable children

3. New Features • New treatment options • Adults: 1st and 2nd line ART • Children: ART and cotrimoxazole • Updated progression periods • New infection to need for treatment • Need for treatment to AIDS death w/wo treatment • Expanded PMTCT options • Calibrate to multiple national surveys • Uncertainty analysis

4. Country data Demographic data Adult prevalence ------------------------- MTCT program description PMTCT coverage Adult ART coverage Child treatment coverage Epidemic patterns Effect of HIV on fertility Progression from infection to need for treatment and to AIDS death Sex ratio of prevalence Age distribution of infection Mother-to-child transmission rates by regimen and feeding options Effect of child treatment Inputs required

5. Creating a new projection

6. Population Projection

7. Population Projection

8. Population Projection The first year of the projection must be before the start of the AIDS epidemic, usually 1980

9. Population Projection The last year of the projection can be anything up to 50 years, but it is best to match the prevalence estimate (2012 for EPP, 2007 for the Workbook)

10. Population Projection

11. Population Projection

12. Population Projection Creates a projection using the UN Population Division’s World Population Prospects

13. Entering data

14. Selecting inputs to edit

15. Adult HIV Prevalence

16. Adult HIV Prevalence

17. Documenting sources

18. Effect of HIV on fertility

19. Effect of HIV on fertility 15-19: 50% increase 20-49: 30% decrease TFR of HIV- adjusted to leave population TFR unchanged

20. Age and Sex Ratio of HIV Prevalence

21. Ratio of prevalence at each to prevalence at 25-29 : Females

22. Ratio of prevalence at each to prevalence at 25-29 : Males

23. Age and Sex Ratio of HIV Prevalence

24. Sex ratio of HIV prevalence

25. Sex ratio of HIV prevalence

27. Progression from HIV Infection to AIDS Death (Adults) New HIV Infection Need for Treatment First Line ART AIDS Death Need for 2nd Line Second Line ART

28. 0 1 Net survival adjusted to age 25-29 Source: Zaba and Todd, Alpha network

29. Time from AIDS or CD4<200 to death in the absence of HAART Source: Zwahlen and Egger

30. Time from CD4 < 350 to death, and from CD4 < 350 combined with WHO stage III or IV to death in resource limited settings Source: Zwahlen and Egger

31. Incidence (%) of Death After Starting ART Source: Dabis et al, ISPED

32. Progression from HIV Infection to AIDS Death (Adults) New HIV Infection Normal M 7.5yrs/F 8.5yrs, fast 6.1/6.9 Need for Treatment First Line ART 3 years 15% FY / 5% SY 3 years AIDS Death Need for 2nd Line 15%/5% Second Line ART

33. Progression from HIV Infection to AIDS Death (Children) New HIV Infection Marston and Newell, median = 2 years Need for Treatment Age-dependent >5 = 3 years AIDS Death First Line ART <1, 0.80 >1, 0.9 first year, else 0.95

36. Adult Male Progression without Treatment

37. Adult Male Progression with Treatment

38. The Need for ART will change from 2005 estimate!

42. Projections of Adult ART Coverage

46. Orphans % women 15-19 never married: 38%-94% (71%) % married women in monogamous union: 45%-96% (71%)

47. Spectrum outputs

48. Various displays are available

49. Comparing effects • Display up to four projections at one time • Open same projection twice and rename to create comparison scenarios

50. Estimates of Need