# Estimating the cascade of HIV care under incomplete outcome ascertainment

> **NIH NIH R21** · INDIANA UNIVERSITY INDIANAPOLIS · 2020 · $196,875

## Abstract

PROJECT SUMMARY
Given the worldwide scope of the HIV/AIDS epidemic, efficient provision of therapy and the
accompanying policy and resource-allocation decisions necessary, likewise have a worldwide
scope. One of the components of this response is the accumulation of information and data to
support evidence-based policy and decision making at the national and international level. To
aid in the coordination of the international response to the HIV/AIDS epidemic, the Joint United
Nations Programme on HIV/AIDS (UNAIDS) has undertaken a major initiative to use data from
all relevant sources to derive estimates of HIV prevalence in adults and children around the
world. These data inform decision and policy-making and help allocation of human and financial
resources to combat HIV/AIDS. At the core of this effort is the SPECTRUM model, which
generates estimates and projections for every country worldwide and helps to assess the impact
of targets such as 90-90-90 and guidelines like universal test and treat. Over the past decade,
the International Epidemiology Databases to Evaluate AIDS (IeDEA) worldwide collaboration
has developed a close relationship with UNAIDS, providing programmatic data as inputs to the
SPECTRUM model. IeDEA and particularly our group (the East Africa IeDEA Regional
Consortium), has developed statistical methods to address problems in estimates of mortality
and patient retention based on data collected as part of routine clinical care, which stem from
unreported mortality in patients lost to programs. We have shown how ascertaining vital status
and treatment access on a sample of patients lost to care, who were subsequently traced in the
community, we can statistically adjust estimates of mortality and patient retention for an entire
program cohort. These methods will be extended to multi-state models of the entire HIV
cascade of care, from enrollment into care and antiretroviral treatment (ART) initiation to death,
and used to provide rigorous, data-driven inputs to SPECTRUM and other mathematical models
(Specific Aim 1). To develop truly global estimates, even in settings where patient tracing is not
available, we will extend our methodology to borrow from the experience of programs with
available tracing data and, using the clinical data at a new setting, provide adjusted estimates of
mortality and patient retention in programs with no tracing data (Specific Aim 2). In this manner,
a hitherto unavailable global picture of HIV care and treatment in the post-ART-scale-up world
and in the era of Universal Test and Treat will emerge.

## Key facts

- **NIH application ID:** 9955180
- **Project number:** 5R21AI145662-02
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Giorgos Bakoyannis
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $196,875
- **Award type:** 5
- **Project period:** 2019-06-17 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9955180

## Citation

> US National Institutes of Health, RePORTER application 9955180, Estimating the cascade of HIV care under incomplete outcome ascertainment (5R21AI145662-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9955180. Licensed CC0.

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