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Title: Estimation of the size and characteristics of HIV-positive populations in Europe
Author: Nakagawa, F.
ISNI:       0000 0004 7229 4108
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2015
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HIV remains a key public health issue, despite the introduction of effective antiretroviral therapy (ART) which has led to huge improvements in the prognosis of HIV-positive individuals. In order to be best informed about an HIV epidemic, it is desirable to have estimates to complement data already available from national and international surveillance, not only on the total number of people living with HIV, but which also describe the characteristics of HIV-positive populations such as the number diagnosed, CD4 count and viral load distribution and the cascade of care. The aims of this thesis were to develop a method based on an individual-based progression model of HIV and the effect of ART to reconstruct and hence better understand the HIV-positive population, for use in Europe. Using this model, I first investigated the projected life expectancy of men-who-have-sex-with-men (MSM) according to timing of diagnosis. I then updated the model to incorporate new data after a review of the literature as well as statistical analyses of viral load and CD4 count changes in the absence of ART, based on data from a large pan-European cohort collaboration. Next, I developed a method using data on MSM in the UK, which calibrates the model to observational and surveillance data of HIV from European countries, and then uses the parameter sets which best fit to the observed data to describe the status of their HIV-positive populations. Plausibility ranges are also estimated to reflect the uncertainty regarding any model parameters. The method is also applied to data on MSM in the Netherlands, and for all HIV-positive individuals in Spain and Estonia. The advantages and disadvantages of this approach compared with other existing approaches are considered. To conclude, I reflect on future modelling needs that are particularly relevant to informing public health in Europe.
Supervisor: Phillips, A. N. ; Smith, C. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available