Summary: Projections of AIDS incidence are critical for assessing future healthcare needs. This paper focuses on the method of back-calculation for obtaining forecasts. The first problem faced was the need to account for delays and underreporting in reporting of cases and to adjust the incidence data The method used to estimate the reporting delay distribution is based on Poisson regression and involves cross-classifying each reported case by calendar time of diagnosis and reporting delay. The adjusted AIDS incidence data are then used to obtain short-term projections and lower bounds on the size of the AIDS epidemic. The estimation procedure ‘back-calculates’, from AIDS incidence data using the incubation period distribution to obtain estimates of the numbers previously infected. These numbers are then projected forward.
The problem can be shown to reduce to estimating the size of a multinomial population. The expectation-maximization (EM) algorithm is used to obtain maximum-likelihood estimates when the density of infection times is parametrized as a step function. The methodology is applied to AIDS incidence data in Portugal for four different transmission categories: injecting drug users, sexual transmission (homosexual/bisexual and heterosexual contact) and others, mainly haemophilia and blood transfusion related, to obtain short-term projections and an estimate of the minimum size of the epidemic.