Modeling the long-term impacts of adult HIV and AIDS on affected children

Transcription

1 Modeling the long-term impacts of adult HIV and AIDS on affected children Chris Desmond Human Sciences Research Council, South Africa PEPFAR, USAID, CDC, LMG and HSRC Washington, DC: 2 October 2014 Social science that makes a difference

2 What and why? Predicting the future or understanding the present? Question the data: Concentrating, clustering and compounding Level and frequency of risk Characteristic and context interaction Alternative metrics Model of the impacts of maternal HIV on children The impact of maternal state, socio-economic status, and child age and gender on: School enrolment Mental health Physical and emotional abuse Sexual risk behaviour: debut and condom use

3 Model structure RISK ENVIRONMENT Incidence, progression, diagnosis, treatment, adherence & mortality rates MALE AGE Prior abuse Child outcome models HIGH INCOME LOW INCOME HIV HIV+ Symptomatic HIV HIV+ Symptomatic Dea d Dea d HIV+ Asymptomatic HIV+ on treatment HIV+ Asymptomatic HIV+ on treatment Maternal health & economic status Age & state specific fertility Maternal health & economic status Age & state specific fertility FEMALE MALE FEMALE AGE AGE AGE No prior abuse Prior abuse No prior abuse Prior abuse No prior abuse Prior abuse Child outcome models Child outcome models Child outcome models Child outcome models Child outcome models Child outcome models Incidence, progression, diagnosis, treatment, adherence & mortality rates No prior abuse Child outcome models

4 Risks without HIV

5 Women s state, no HIV Alive Deceased

6 Age Specific Fertility Rate

7 Mother state, by child s age

8 Risks with HIV

9

10

11

12

13 With HIV The results presented here are based on South African data. Best to use as much data as possible from a single context. Cohort of 100,000 women Fertility and Mortality rates: state specific Incidence, diagnosis, treatment and adherence rates 50% poverty Risks based primarily on the young carers study:

14 Women s State, by age HIV Asymptomatic and undiagnosed Symptomatic and undiagnosed Asymptomatic and diagnosed Symptomatic and diagnosed On treatment Stopped treatment Deceased

15 Age and State Specific Fertility Rate

16 Base scenario

17 Model structure RISK ENVIRONMENT Incidence, progression, diagnosis, treatment, adherence & mortality rates MALE AGE Prior abuse Child outcome models HIGH INCOME LOW INCOME HIV HIV+ Symptomatic HIV HIV+ Symptomatic Dea d Dea d HIV+ Asymptomatic HIV+ on treatment HIV+ Asymptomatic HIV+ on treatment Maternal health & economic status Age & state specific fertility Maternal health & economic status Age & state specific fertility FEMALE MALE FEMALE AGE AGE AGE No prior abuse Prior abuse No prior abuse Prior abuse No prior abuse Prior abuse Child outcome models Child outcome models Child outcome models Child outcome models Child outcome models Child outcome models Incidence, progression, diagnosis, treatment, adherence & mortality rates No prior abuse Child outcome models

18 School model

19 School enrolment Population outcomes without HIV Population outcomes with HIV Children affected by maternal HIV

20 School completion Children affected by maternal HIV Population outcomes with HIV Population outcomes without HIV

21 Percentage of children suffering at least one episode of depression or anxiety by age 18 Population outcomes: without HIV Population outcomes: with HIV Children affected by maternal HIV

22 Cumulative percentage of children suffering at least one episode of depression or anxiety, by age and clustering of risk factors Population outcomes with HIV Girls/high income/no abuse/mother alive and HIV- Girls/low income/prior abuse/mother deceased

23 Percentage of children suffering at least one incident of emotional or physical abuse by age 18 Population outcomes without HIV Population outcomes with HIV Children affected by maternal HIV

24 Intervention

25 Base scenario

26 Prevention

27 Base scenario

28 Treatment

29 Mother deceased, by child age

30 Mother deceased, by child age

31 Mother deceased, by child age

32 Mother deceased, by child age

33 Reducing the population level impact on schooling 80% HIV no treatment Baseline High treatment and adherence Prevention Poverty reduction 60% 40% 20% 0% -20% -40% -60% -80% -100% -120%

34 Reducing the population level impact on schooling 80% HIV no treatment Baseline High treatment and adherence Prevention Poverty reduction 60% 40% 20% 0% -20% -40% -60% -80% -100% -120%

35 Limitations Adult caregivers other than the mother are not included. Data limitations: Consequences of HIV exposure during pregnancy, poor nutrition, child labour and reduced access to health care not included. Risks of abuse, depression and anxiety, prior to 12 years of age, are not included. Impact of PMTCT interventions on diagnoses and timely uptake of treatment were not modelled More pathways modelled, more impact accounted for: Consider poverty interaction Vs poverty increase

36 Implications 1. Widespread risk large scale prevention of harm, removing risk factors. 2. Concentrated and clustered consequences intensive targeted mitigation interventions. 3. Maternal infection, illness and transition to treatment or death occur most often in the first decade of a child s life focus on affected families with young children. 4. Opportunity for combined adherence / family support: double benefit for children 5. Longitudinal data is needed, beginning with children born into affected families, and children of all ages living with adults on treatment.

37 Thank you