The East-West Center’s HIV activities work toward a better understanding of national HIV epidemics, responses to epidemics, and the optimal allocation of limited resources to counter epidemics in ways that maximize their impact. Center researchers and consultants work closely with national partners in almost every country in Asia and with colleagues from other regional and international agencies, including the Joint United Nations Program on HIV/AIDS (UNAIDS); the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and Avenir Health. The Center regularly participates in training activities with global, regional, and national counterparts working to address HIV in their home countries and organizations. Work focuses in three major areas.
Tools for national modeling, impact assessment, and policy analysis: The Asian Epidemic Model (AEM) and the UNAIDS Estimation and Projection Package (EPP)
The East-West Center provides two of the most frequently used models for HIV epidemics in Asia and around the world. The AIDS Epidemic Model (AEM), patterned after the HIV situation in countries with concentrated epidemics, allows countries to build locally tuned models that accurately represent their epidemiological situation. These models can then be used with a set of analytic tools—the AEM Workbooks (Baseline, Intervention, and Impact Analysis)—to prepare scenarios that analyze alternative responses to the epidemic, assess the impact of these responses, and estimate the cost of their implementation. These scenarios provide essential inputs to national strategic planning processes, help countries allocate their resources more efficiently, and help countries identify weaknesses that must be addressed to strengthen their responses.
The East-West Center is also the primary developer of the UNAIDS Estimation and Projection Package (EPP) component of Spectrum under the guidance of the UNAIDS Reference Group on Estimation and Projection. EPP plays an essential role by fitting surveillance data to help prepare national and global estimates of HIV and estimate prevention/treatment needs for planning and budgeting. EPP is used in almost all African countries for estimation and projection and is also applied in most countries with low-level and concentrated epidemics, such as those in Asia and Latin America. If desired, AEM also links to Spectrum to allow countries, mainly in Asia, to use their AEM models to contribute to global estimates of HIV. The Center’s modeling tools are periodically updated to address newly arising prevention and treatment options, adapt to match country needs, and meet the evolving requirements of policy and programmatic analyses.
Support for development of these two models and the associated tools has been provided by a number of partners over the years including UNAIDS, the Global Fund, the United States Agency for International Development (USAID), the World Health Organization (WHO), the World Bank, and others.
Application of modeling and policy-analysis tools to make better use of resources and strengthen responses
In addition to developing modeling and policy-analysis tools, the East-West Center provides support for applying these tools in countries in an inclusive and participatory manner. Building from the Center’s unique collaborative approach to addressing issues of regional concern, Center researchers and consultants work closely with international technical partners and national counterparts to apply AEM, EPP, and associated policy-analysis tools to the development of national HIV projections, investment cases, inputs for national strategic planning, and materials to support the preparation of Global Fund concept notes. The focus in these areas is on making better use of the resources available, identifying the combination of programs likely to have the highest impact at a given resource level, and advocating for the resources needed to reverse national epidemics. In recent years, the Center has supported development of investment cases, national strategic plans, and Global Fund concept notes for Bangladesh, Cambodia, Hong Kong, Indonesia, Lao People’s Democratic Republic (PDR), Malaysia, Myanmar, Nepal, the Philippines, Thailand, and Vietnam.
Training to build effective national and regional responses
The East-West Center regularly supports capacity-building efforts both in countries and in regional/global settings and also provides technical support for specific applications of modeling and policy-analysis tools. The in-country AEM process normally involves multiple collaborative meetings to maximize the participation of national stakeholders, take advantage of locally available data, build in-country policy-analysis capacity, and ensure country ownership of the models and policy-analysis products. The Center also works closely with international partners to organize training activities on estimation, projection, and policy modeling; to support the development of stronger strategic-information systems; and to improve the availability of the data needed to guide national responses. The Center’s A2 (Analysis and Advocacy) guidelines provide a solid framework for translating analysis into action.
Support for the application of modeling and policy-analysis tools and training to use these tools comes from UNAIDS Geneva, the UNAIDS Regional Support Team for Asia and the Pacific, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Applications of East-West Center modeling tools; Project reports
Brown, Tim, Le Bao, Jeffrey W. Eaton, Daniel R. Hogan, Mary Mahy, Kimberly Marsh, Bradley M. Mathers, and Robert Puckett (2014). Improvements in prevalence trend fitting and incidence estimation in EPP 2013. AIDS 28(Suppl 4): S415–25.
Bao, Le, Joshua A. Salomon, Tim Brown, Adrian E. Raftery, and Daniel R. Hogan (2012). Modelling national HIV/AIDS epidemics: Revised approach in the UNAIDS Estimation and Projection Package. Sexually Transmitted Infections 88(Suppl. 2): i3–10.
Fazito, Erika, Paloma Cuchi, Mary Mahy, and Tim Brown (2012). Analysis of duration of risk behavior for most at-risk populations: A systematic literature review. Sexually Transmitted Infections 88(Suppl. 2): i24–32.
Gouws, Eleanor, and Paloma Cuchi on behalf of the International Collaboration on Estimating HIV Incidence by Modes of Transmission (2012). Focusing the HIV response through estimating the major modes of HIV transmission: A multi-country analysis. Sexually Transmitted Infections 88(Suppl. 2): i76–85.
Stover, John, Tim Brown, and Milly Marston (2012). Updates to the Spectrum/EPP Model to estimate HIV trends for women and children. Sexually Transmitted Infections 2012(88): i11–16.
Azim, Tasnim, Tobi J. Saidel, and Tim Brown (2010). Essential elements of strategic information systems to guide focused HIV responses in South and Southeast Asia. AIDS 24(Suppl. 3): S54–61.
Brown, Tim, L. Bao, A. Raftery, J. Salomon, R. Baggaley, J. Stover, and P. Gerland (2010). Modeling HIV epidemics in the antiretroviral era: The UNAIDS Estimation and Projection package 2009. Sexually Transmitted Infections 86(Suppl. 2): ii3-10.
Komatsu, Ryuichi, Ross McLeod, Swarup, Sarkar, Nalyn Siripong, Indrani Gupta, Viro Tangcharoensathien, Tim Brown, Tim, Jacques Jeugmans, Carlos Avila-Figueroa, and Rifat Atun (2010). Asia can afford universal access for AIDS prevention and treatment. AIDS 24(Suppl. 3): S72–79.
Brown, Tim, Margot Fahnestock, Gayle Martin, Wiwat Peerapatanapokin, Dimitri Prybylski Amala Reddy, Jeremy Ross, Tobi Saidel, Nalinee Sangrujee, Chris Ward, and the A2 country teams (2009). From analysis to action: The A2 approach. Durham, North Carolina: Family Health International, East-West Center, RTI International, and Futures Group International.
de Lind van Wijngaarden, Jan W., Tim Brown, Philippe Girault, Swarup Sarkar, and Frits van Griensven (2009). The Epidemiology of Human Immunodeficiency Virus infection, sexually transmitted infections, and associated risk behaviors among men who have sex with men in the Mekong Subregion and China: Implications for policy and programming. Sexually Transmitted Diseases 36(5): 319–24.
Brown, Tim, J.A. Salomon, L. Alkema, A.E. Raftery, and E. Gouws (2008). Progress and challenges in modelling country-level HIV/AIDS epidemics: The UNAIDS Estimation and Projection Package 2007. Sexually Transmitted Infections 84(Suppl. 1): i5–10.
Brown, Tim (2006). HIV/AIDS in Hong Kong: Living on the edge. Hong Kong: Red Ribbon Centre-UNAIDS Collaborating Centre for Technical Support, Centre for Health Protection, Department of Health.
Brown Tim, N. Grassly, G. Garnett, and K. Stanecki (2006). Improving projections at the country level: The UNAIDS Estimation and Projection Package 2005. Sexually Transmitted Infections 82(Suppl. 3): iii34–40.
Gouws E., P. White, J. Stover, and Tim Brown (2006). Short-term estimates of HIV incidence by mode of transmission: Kenya and Thailand as examples. Sexually Transmitted Infections 82(Suppl. 3): iii51–55.
Brown, Tim, and Werasit Sittitrai (2005). Making the right choices—protecting Asian-Pacific children and youth from HIV. In G. Foster, J. Williamson, and C. Levine, eds. A Generation at risk: The global impact of AIDS on orphans and vulnerable children. Cambridge: Cambridge University Press.
Chen, Jiajian, Minja Kim Choe, Shengli Chen, and Shikun Zhang (2005). Community environment and HIV/AIDS-related stigma in China. AIDS Education and Prevention 17(1): 1–11.
Diaz, Theresa, Kevin De Cock, Tim Brown, Peter D. Ghys, and J. Ties Boerma (2005). New strategies for HIV surveillance in resource-constrained settings: An overview. AIDS 19(Suppl. 2): S1–8.
Pervilhac, Cyril, John Stover, Elizabeth Pisani, Tim Brown, Ruben Mayorga, Owen Mugurungi, Mohammed Shaukat, Lu Fan, and Peter D. Ghys (2005). Using HIV surveillance data: Recent experiences and avenues for the future. AIDS 19(Supp. 2): S53–58.
Brown, Tim (2004). Tackling the HIV/AIDS Epidemic in Asia. Asia-Pacific Population and Policy. No. 68. Honolulu: East-West Center.
Brown, Tim (2004). The generation game: How HIV affects young people in Asia. In Elizabeth Pisani and Hein Marais, eds. AIDS in Asia: Face the facts: A comprehensive analysis of the AIDS epidemics in Asia. Bangkok: Monitoring the AIDS Pandemic (MAP) Network.
Brown, Tim (2004). What next? Epidemic dynamics in the Asian context. In Elizabeth Pisani and Hein Marais, eds. AIDS in Asia: Face the facts: A comprehensive analysis of the AIDS epidemics in Asia. Bangkok: Monitoring the AIDS Pandemic (MAP) Network.
Brown, Tim, and W. Peerapatanapokin (2004). The Asian Epidemic Model: A process model for exploring HIV policy and programme alternatives in Asia. Sexually Transmitted Infections 80(Suppl. 1): i19–24.
Chen, Shengli, Zhang Shikun, and Sidney B. Westley (2004). HIV/AIDS awareness is improving in China. Asia-Pacific Population & Policy No. 69. Honolulu: East-West Center.
Chen, Shengli, Zhengyu Xiao, Jiajian Chen, Shikun Zhang, Faming Gu, Liming Zhang, Lixia Mo, Minghua Zhang, Sidney Bohanna Westley, Miguel Babatunde Richard Savage, Pingan Liu, and Xingzheng Feng (2004). Report of survey and evaluation on HIV/AIDS prevention project [in Chinese and English]. Beijing: China Population Press.
Ghys, P., Tim Brown, N.C. Grassly, G. Garnett, K.A. Stanecki, J. Stover, and N. Walker (2004). The UNAIDS Estimation and Projection Package: A software package to estimate and project national HIV epidemics. Sexually Transmitted Infections 80(Suppl. 1): i5–9.
Grassly, N.C., M. Morgan, N. Walker, G. Garnett, A. Stanecki, J. Stover, Tim Brown, and P.D. Ghys (2004). Uncertainty in estimates of HIV/AIDS: The estimation and application of plausibility bounds. Sexually Transmitted Infections 80(Suppl. 1): i31–38.
Mills, S., T. Saidel, R. Magnani, and Tim Brown (2004). Surveillance and modeling of HIV, STI, and risk behaviours in concentrated HIV epidemics. Sexually Transmitted Infections 80(Suppl. 2): ii57–62.
Ruxrungtham, Kiat, Tim Brown, and Praphan Phanuphak (2004). HIV/AIDS in Asia. Lancet 364(9428): 69–82.
Brown, Tim (2003). HIV/AIDS in Asia. AsiaPacific Issues No. 68. Honolulu: East-West Center.
Chen, Jiajian, Chen Shengli, and Minja Kim Choe (2003). Who has correct information and knowledge about HIV/AIDS in China? In Shikun Zhang, Jason Hsia, and Lixia Mo, eds. Waking up: Reports on data analysis of Baseline Survey for HIV/AIDS Prevention. Beijing: China Population Press.
Chen, Jiajian, Chen Shengli, and Minja Kim Choe (2003). Who has correct information and knowledge about HIV/AIDS in China? Asia-Pacific Population Journal 8(4): 25–38.
Brown, Tim (2002). The HIV/AIDS epidemic in Asia. Asia-Pacific Population and Policy No. 60. Honolulu: East-West Center.
Chen, Sheng Li, Shi Kun Zhang, Li Xia Mo, and Shu Zhang Yang (2002). HIV/AIDS in China: Survey provides guidelines for improving awareness. Asia-Pacific Population and Policy No. 62. Honolulu: East-West Center.