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Challenges in modelling the proportion of undiagnosed HIV infections in Sweden

Andersson, E; Nakagawa, F; van Sighem, A; Axelsson, M; Phillips, AN; Sönnerborg, A; Alber, J; (2019) Challenges in modelling the proportion of undiagnosed HIV infections in Sweden. Eurosurveillance , 24 (14) , Article 1800203. 10.2807/1560-7917.ES.2019.24.14.1800203. Green open access

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Abstract

BACKGROUND: Sweden has a low HIV prevalence. However, among new HIV diagnoses in 2016, the proportion of late presenters and migrants was high (59% and 81%, respectively). This poses challenges in estimating the proportion of undiagnosed persons living with HIV (PLHIV). AIM: To estimate the proportion of undiagnosed PLHIV in Sweden comparing two models with different demands on data availability and modelling expertise. METHODS: An individual-based stochastic simulation model of HIV positive populations (SSOPHIE) and the incidence method of the European Centre for Disease Prevention and Control (ECDC) HIV Modelling Tool were applied to clinical, surveillance and migration data from Sweden 1980–2016. RESULTS: SSOPHIE estimated that the proportion of undiagnosed PLHIV in 2013 was 26% (n = 2,100; 90% plausibility range (PR): 900–5,000) for all PLHIV, 17% (n = 600; 90% PR: 100–2,000) for men who have sex with men (MSM), 35% in male (n = 300; 90% PR: 200–700) and 34% in female (n = 400; 90% PR: 200–800) migrants from sub-Saharan Africa (SSA). The estimates for the ECDC model in 2013 were 21% (n = 2,013; 95% confidence interval (CI): 1,831–2,189) for all PLHIV, 15% (n = 369; 95% CI: 299–434) for MSM and 21% (n = 530; 95% CI: 436–632) for migrants from SSA. CONCLUSIONS: The proportion of undiagnosed PLHIV in Sweden is uncertain. SSOPHIE estimates had wide PR. The ECDC model estimates were unreliable because migration was not accounted for. Better migration data and estimation methods are required to obtain reliable estimates of proportions of undiagnosed PLHIV in similar settings.

Type: Article
Title: Challenges in modelling the proportion of undiagnosed HIV infections in Sweden
Open access status: An open access version is available from UCL Discovery
DOI: 10.2807/1560-7917.ES.2019.24.14.1800203
Publisher version: http://doi.org/10.2807/1560-7917.ES.2019.24.14.180...
Language: English
Additional information: © 2019 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence (http://creativecommons.org/licenses/by/4.0/).
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10073659
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