Search

Introduction: The third of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is to achieve a 90% rate of viral suppression (HIV viral load Methods: We considered three possible distributions for viral loads in ART patients: Weibull, Pareto and reverse Weibull (imposing an upper limit but no lower limit on the log scale). The models were fitted to data on viral load distributions in ART patients in the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration (representing seven global regions) and the ART Cohort Collaboration (representing Europe), using separate random effects models for adults and children. The models were validated using data from the World Health Organization (WHO) HIV drug resistance report and the Brazilian national ART programme. Results: Models were calibrated using 921,157 adult and 37,431 paediatric viral load measurements, over 2010-2019. The Pareto and reverse Weibull models provided the best fits to the data, but for all models, the 'shape' parameters for the viral load distributions differed significantly between regions. The Weibull model performed best in the validation against the WHO drug resistance survey data, while the Pareto model produced uncertainty ranges that were too narrow, relative to the validation data. Based on these analyses, we recommend using the reverse Weibull model. For example, if a country reports an 80% rate of viral suppression at Conclusions: Estimates of viral suppression can change substantially depending on the threshold used in defining viral suppression. It is, therefore, important that viral suppression rates are standardized to the same threshold for the purpose of assessing progress towards UNAIDS targets. We have proposed a simple adjustment that allows this, and this has been incorporated into UNAIDS modelling software. Keywords: antiretroviral therapy; HIV; viral load, 1 | INTRODUCTION Antiretroviral treatment (ART) is highly effective in preventing the replication of HIV, which is crucial to restoring the immune systems of people living with HIV [1], improving [...]

Introduction: The Case Surveillance and Vital Registration (CSAVR) model within Spectrum estimates HIV incidence trends from surveillance data on numbers of new HIV diagnoses and HIV-related deaths. This article describes developments of the CSAVR tool to more flexibly model diagnosis rates over time, estimate incidence patterns by sex and age group and by key population group. Methods: We modelled HIV diagnosis rate trends as a mixture of three factors, including temporal and opportunistic infection components. The tool was expanded to estimate incidence rate ratios by sex and age for countries with disaggregated reporting of new HIV diagnoses and AIDS deaths, and to account for information on key populations such as men who have sex with men (MSM), males who inject drugs (MWID), female sex workers (FSW) and females who inject drugs (FWID). We used a Bayesian framework to calibrate the tool in 71 high-income or low-HIV burden countries. Results: Across countries, an estimated median 89% (interquartile range [IQR]: 7896-9696) of HIV-positive adults knew their status in 2019. Mean CD4 counts at diagnosis were stable over time, with a median of 456 cell/[micro]l (IQR: 391-508) across countries in 2019. In European countries reporting new HIV diagnoses among key populations, median estimated proportions of males that are MSM and MWID was 1.3% (IQR: 0.996-2.0%) and 0.5696 (IQR: 0.5196-0.6496), respectively. The median estimated proportions of females that are FSW and FWID were 0.3696 (IQR: 0.2796-0.4596) and 0.14 (IQR: 0.1396-0.1596), respectively. HIV incidence per 100 person-years increased among MSM, with median estimates reaching 0.43 (IQR: 0.29-1.73) in 2019, but remained stable in MWID, FSW and FWID, at around 0.12 (IQR: 0.04-1.9), 0.09 (IQR: 0.06-0.69) and 0.1396 (IQR: 0.0896-0.9196) in 2019, respectively. Knowledge of HIV status among HIV-positive adults gradually increased since the early 1990s to exceed 7596 in more than 7596 of countries in 2019 among each key population. Conclusions: CSAVR offers an approach to using routine surveillance and vital registration data to estimate and project trends in both HIV incidence and knowledge of HIV status. Keywords: HIV case-based surveillance; HIV incidence; HIV-related mortality; key population; knowledge of status; statistical models, 1 | INTRODUCTION The Joint United Nations Programme on HIV/AIDS (UNAIDS)-supported Spectrum software package is used by most countries in the world to generate annual estimates of HIV burden and [...]

Despite the extensive testing for federal accountability mandates, college students' understanding of federal accountability testing (e.g., No Child Left Behind, Race to the Top, Spellings) has not been examined, resulting in a lack of knowledge regarding how such understanding (or lack thereof) impacts college students' behavior on accountability tests in higher education contexts. This study explores college students' understanding and misconceptions of federal accountability testing in K-12. To this end, we crafted nine multiple choice items with four distracters and piloted these items with two college student samples. The results indicated that college students tend to be moderately confident in their responses regardless of the accuracy of the response. These findings imply that educating students on the purpose and process of accountability testing will require not only imparting correct information, but also debunking misconceptions.

Given worldwide prevalence of low-stakes testing for monitoring educational quality and students' progress through school (e.g., Trends in International Mathematics and Science Study, Program for International Student Assessment), interpretability of resulting test scores is of global concern. The nonconsequential nature of low-stakes tests can undermine students' test-taking motivation, artificially deflating performance and thus jeopardizing validity of test-based inferences, whether they pertain to programs, institutions, or nations (Eklöf, 2007, 2010; Stanat & Lüdtke, 2013; Wise & DeMars, 2005). Moreover, students in countries such as the United States, where academic progress over the course of K-12 (kindergarten through Grade 12) is systematically assessed, are likely to develop antagonistic attitudes toward low-stakes testing by the time they enter college. The relationship between such attitudes, test-taking motivation, and performance on a low-stakes university accountability test was modeled via path analysis. Results indicated the effects of attitudes were indirect (via test-taking motivation) and minimal, suggesting the influence of attitudes on test performance is negligible, further supporting the validity of inferences made from such low-stakes tests. Implications for international assessment are discussed.

In the United States, government mandates for educational accountability have prompted an increase in testing in K-12 and higher education settings, resulting in a generation of millennial students who have undergone repeated assessment over the course of their educational careers. The cumulative effects of testing may range from increasingly antagonistic attitudes towards assessment to undesirable test-taking behavior, thereby compromising validity of inferences made from test scores. Even though validity of accountability testing is at the forefront of the debate on educational reforms, the role of students' attitudes as determinants of test scores is not well understood. The current study focused on the construction of two new measures of students' attitudes toward institutional accountability testing in K-12 (SAIAT-K-12) and in higher education (SAIAT-HE). The dimensionality of these measures, as well as their utility for examining the link between students' attitudes and test performance, are discussed.

Background: In June 2001, the United Nations General Assembly Special Session (UNGASS) set a target of reducing HIV prevalence among young women and men, aged 15 to 24 years, by 25% in the worst‐affected countries by 2005, and by 25% globally by 2010. We assessed progress toward this target in Manicaland, Zimbabwe, using repeated household‐based population serosurvey data. We also validated the representativeness of surveillance data from young pregnant women, aged 15 to 24 years, attending antenatal care (ANC) clinics, which UNAIDS recommends for monitoring population HIV prevalence trends in this age group. Changes in socio‐demographic characteristics and reported sexual behaviour are investigated. Methods: Progress towards the UNGASS target was measured by calculating the proportional change in HIV prevalence among youth and young ANC attendees over three survey periods (round 1: 1998‐2000; round 2: 2001‐2003; and round 3: 2003‐2005). The Z‐score test was used to compare differences in trends between the two data sources. Characteristics of participants and trends in sexual risk behaviour were analyzed using Student's and two‐tailed Z‐score tests. Results: HIV prevalence among youth in the general population declined by 50.7% (from 12.2% to 6.0%) from round 1 to 3. Intermediary trends showed a large decline from round 1 to 2 of 60.9% (from 12.2% to 4.8%), offset by an increase from round 2 to 3 of 26.0% (from 4.8% to 6.0%). Among young ANC attendees, the proportional decline in prevalence of 43.5% (from 17.9% to 10.1%) was similar to that in the population (test for differences in trend: p value = 0.488) although ANC data significantly underestimated the population prevalence decline from round 1 to 2 (test for difference in trend: p value = 0.003) and underestimated the increase from round 2 to 3 (test for difference in trend: p value = 0.012). Reductions in risk behaviour between rounds 1 and 2 may have been responsible for general population prevalence declines. Conclusions: In Manicaland, Zimbabwe, the 2005 UNGASS target to reduce HIV prevalence by 25% was achieved. However, most prevention gains occurred before 2003. ANC surveillance trends overall were an adequate indicator of trends in the population, although lags were observed. Behaviour data and socio‐demographic characteristics of participants are needed to interpret ANC trends., Background In June 2001, the United Nations General Assembly Special Session (UNGASS) set a target of reducing HIV prevalence among youth, aged 15 to 24 years, by 25% in the [...]