Back-projection and sensitivity analysis of the HIV-AIDS epidemic in the Caribbean

In this study we estimated past human immunodeficiency virus (HIV) incidence in 19 nations in the primarily English-speaking Caribbean and projected the course of the epidemic to the year 1999. We compared the results obtained from several different models of HIV incidence and different assumed incubation distributions. Linear and nonlinear optimization methods were used to fit several models (power, logistic, spline, and step) to adult (age 15 years or older) AIDS incidence data derived from our existing surveillance system. All four models tested gave good fits to the data, with estimates of cumulative HIV incidence in 1993 ranging from 16,504 to 21,732. An increase in the assumed median of the AIDS incubation distribution by one year increased the estimates of current cumulative adult HIV incidence by approximately 12%; these estimates varied by as much as 6% between models. An adjustment of the data for possible reporting delay increased the estimates by approximately 7% and for underreporting by 25%. Despite their sensitivity to underlying assumptions, back-projection estimates provide useful insights into the patterns of HIV and AIDS incidence. The models indicate that HIV and AIDS incidences in the English-speaking Caribbean have been rising steadily, with adult HIV prevalence in the general population still less than 1%.