Application Of The Estimation And Projection Package(EPP) In Estimation And Projection Of HIV/AIDS Epidemic In Hongkou District, Shanghai

[Objective]1To analyze the epidemic trend and distribution characteristics of reported HIV/AIDS cases of Hongkou District from1990to2010.2To apply EPP model for estimating and projecting the HIV/AIDS epidemic in Hongkou District.[Methods]1Studied on the reported HIV/AIDS epidemic by epidemic analysis methods.2The total human population with ages of15years old and above in Hongkou District was categorized into6sub-populations:4groups at high risk composed of Injection drug users (IDU), Female sex workers (FSW), Client, and Men who have sex with men (MSM), and the other2general groups comprising Male remaining population (RM) and Female remaining population (RF). Each sub-population size was estimate, and social and demographic data as well as all information about the HIV/AIDS epidemic of Hongkou District (such as surveillance data and anti-retroviral therapy (ART) data) were collected, managed and input to EPP models. Then EPP model was implemented to estimate and predict the epidemic statues and trend of HIV/AIDS in Hongkou District, and to evaluate the supply/demand ratio of ART. Sensitivity analysis was also conducted by adjusting prevalence of HIV in MSM sub-population.[Results]1The epidemic trend and distribution characteristics of reported HIV/AIDS cases of Hongkou District from1990to2010.Since the first case of HIV infection was reported in1990, the epidemic of HIV/AIDS increased sharply in Hongkou District, and as of2010a total of313HIV/AIDS were reported. Demographic characteristics of the existing HIV/AIDS cases are list as follow:61.3%without Hongkou District household register, sex ratio4.9:1(male: female), median of age32±12.6years, unmarried45.7%and married45.4%. Among known transmission routes, heterosexual transmission was principal with proportion of42.8%, followed by injecting drug use (27.1%) and homosexual transmission (25.8%). But chronicle analysis revealed that heterosexual transmission was predominant in the1990s, while IDU increased from1997through2008and homosexual transmission emerged as the leading cause in recently5years. 2Estimation and projection of HIV/AIDS epidemic in Hongkou District by EPP model.Based on the implementation of EPP model, there was no significant difference among estimated prevalence of HIV by fitting the model with small, middle and large size of sub-populations, which were0.06%,0.08%and0.10%in2010, and predicted0.14%,0.19%and0.23%in2015, respectively, in Hongkou District. Further analysis using the estimated prevalence by middle size of sub-populations showed that fitting curves of HIV prevalence was increasing within a low level in all sub-populations except in MSM, in which the prevalence was high and expanded rapidly from7.8%in2010to predicted21.0%in2015. Compared with real number of notifiable cases, estimated first case in Hongkou District was in1988(really in1990) and there were predicted659cases up to2010(really313cases), while incidence and accumulated number would be265and1576in2015, respectively. It also predicted that HIV/AIDS cases in need of anti-virus treatment was increasing since2007:36cases in2005,51cases in2010, and211cases in2015which increased by486.1%and313.7%than those in2005and2010. In reality, the number of cases receiving anti-virus treatment is also increasing and the real number is55which firstly exceeds predicted in2010with ART ratio of107.8%.According to the fitting curve of ’middle size’mode of EPP, the first HIV/AIID case in Hongkou District might occur in1988,2years earlier than1990when the first case was actually reported, and then the proportion of accumulative HIV/AIDS cases to the estimated amount had increased year by year. There would be659accumulative HIV/AIDS cases up to2010(313were actually reported, accounting for47.5%of the estimated), while incidence and accumulated number would be265and1576in2015, respectively. It also predicted that HIV/AIDS cases in need of ART were increasing:36cases in2005.51cases in2010,211cases in2015which would have increased by486.1%comparing that of2005, and by313.7%that of2010. Since the free ART initiated in Hongkou District in2005, the number of HIV/AIDS receiving ART is also increasing and the real number is55which firstly exceeds predicted in2010with supply/demand of ART ratio of107.8%.To evaluate the sensitivity of the model,3plans of model adjustment had been designed through adjusting HIV infection rate of MSM during2007-2010:plan1-to maintain the HIV infection rate of MSM at5%; plan2-to maintain the HIV infection rate of MSM at10%; plan3-to maintain the HIV infection rate of MSM at15%. It showed the range of the HIV infection rate of total human population and HIV/AIDS number were0.15%～0.26%and1218～2191, respectively.[Conclusion] The epidemic of HIV/AIDS remains a low prevalence in Hongkou District, but a rapid upward trend of the epidemic appeared. The ratio of existent cases to predicted cases is increasing annually, suggesting that expanding health promotion, developing surveillance/detection and intervention towards high-risk population are effective. After2005, homosexual transmission increases remarkably and contributes greatly to the epidemic; although there might be overestimate of real data, but it’s still consistent with the previous domestic studies. The cases both in need of and receiving ART are increasing while the latter firstly exceeds the former in2010, suggesting great development and effective coverage of HIV/AIDS management by the government. The health administration needs to make preparations for further emerging demand, especially incorporating diverse interventions.