Global adolescent mortality data Where do the numbers

Global adolescent mortality data: Where do the numbers come from and how can we improve them Mary Mahy, Sc. D UNAIDS, Geneva #AIDS 2016 | @AIDS_conference

Outline 1. Estimates of Adolescent AIDS mortality 2. What sources of data are available – models, empirical data 3. How can we improve surveillance and estimates for adolescents #AIDS 2016 | @AIDS_conference

What do we know about adolescent mortality • Ages 10 -14 and 15 -19 – Very different populations • Moderate declines among all cause mortality – 1. 5 million in 2000 to 1. 3 million in 2012 – relatively healthy population • Updated WHO cause of death ranking underway – Global cause of death ranking rely on UNAIDS estimates* – UNAIDS paediatric estimates revised in 2016 *including both WHO based cause of death and IHME global burden of disease estimates, (see GBD HIV collaborators, Lancet 2016) #AIDS 2016 | @AIDS_conference

UNAIDS estimates • 2016: first year UNAIDS has published adolescent estimates – improved methods – Data from Ie. DEA used to determine age children started ART (default values by region) – Updated transmission probability from mothers to children #AIDS 2016 | @AIDS_conference

Estimates of adolescent HIV Global New HIV infections People living with HIV AIDS deaths Ages 10 -14 <5, 000 ? 640, 000 21, 000 Ages 15 -19 250, 000 1, 100, 000 21, 000 Females Males Ages 10 -19 160, 000 87, 000 250, 000* 680, 000 450, 000 11, 000 10, 000 1, 800, 000* 41, 000* * Age disaggregated values do not add up to total due to rounding #AIDS 2016 | @AIDS_conference

Revised estimates reduce paediatric infections and adolescent AIDS deaths: Other causes of death likely to be higher than AIDS 43. 4 Revised AIDS (2012 value from UNAIDS 2016 estimates) #AIDS 2016 | @AIDS_conference

What influences AIDS deaths among adolescents PMTCT coverage 10 -19 years earlier Overall demographic changes #AIDS 2016 | @AIDS_conference Timing of infection: during pregnancy versus breastfeeding Adolescent AIDS mortality ART coverage and retention among adolescents

Increasing population 10 -19 Source: UN Population Division, World Population Prospects 2015 #AIDS 2016 | @AIDS_conference

Dramatic decline in number of new infections among children due to PMTCT #AIDS 2016 | @AIDS_conference

Survival by timing of infection 50% Marston M, Becquet R. Net survival of children HIV-infected perinatally and through breastfeeding: a pooled analysis of individual data from resource-constrained s ettings, December 2010. #AIDS 2016 | @AIDS_conference 40% 50% Source: UNAIDS 2016 estimates % during pregnancy

ART coverage among adolescents #AIDS 2016 | @AIDS_conference Source: 2016 Global AIDS Progress Reporting and UNAIDS 2016 estimates

Additional ART coverage data #AIDS 2016 | @AIDS_conference

Limited empirical data On mortality…. Source: South African vital registered deaths, corrected for incompleteness, 2014 and UNAIDS 2016 estimates … and prevalence Source: Silhol et al Poster at AIDS 2016. #AIDS 2016 | @AIDS_conference TUPEC 138 Survey confidence intervals are too wide to make meaningful comparisons

Future empirical data needed • Case reporting of HIV by age group • Vital registration by age and cause of death • Larger sample sizes in surveys #AIDS 2016 | @AIDS_conference

Future improvements to estimates • More country data on ART by age group • Data from countries or cohorts on retention differentials by age to determine if change to model structure is required • Improved understanding of survival of perinatally infected young adults (15 -24) – Davies et al 2016 • More empirical data for comparisons • All data by five year age group #AIDS 2016 | @AIDS_conference

AIDSinfo aidsinfo. unaids. org § Global AIDS Response Progress Reporting (GARPR) Indicators § Estimates of new HIV infections, people living with HIV and AIDS deaths by age group and sex § Financial HIV disbursements and expenditures (as reported by donors and countries) #AIDS 2016 | @AIDS_conference § Key Population Atlas: maps on key populations § HIV prevalence, size estimates, testing coverage, laws on criminalization § Trends over years within countries