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Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990-2013.

Granich R, Gupta S, Hersh B, Williams B, Montaner J, Young B, Zuniga JM - PLoS ONE (2015)

Bottom Line: ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively.Over the past decade the expansion of access to ART averted millions of deaths.Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission.

View Article: PubMed Central - PubMed

Affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.

ABSTRACT

Background: Antiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease progression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simulate four treatment scenarios for Nigeria and South Africa.

Methods: For 1990-2013, we used the Joint United Nations Programme on HIV/AIDS (UNAIDS) database to examine trends in AIDS deaths, HIV incidence and prevalence, ART coverage, annual AIDS death rate, AIDS death-to-treatment and HIV infections to treatment ratios for the top 30 countries with the highest AIDS mortality burden and compare them with data from high-income countries. We projected the 1990-2020 AIDS deaths for Nigeria and South Africa using four treatment scenarios: 1) no ART; 2) maintaining current ART coverage; 3) 90% ART coverage based on 2013 World Health Organization (WHO) ART guidelines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020.

Findings: In 2013, there were 1.3 million (1.1 million-1.6 million) AIDS deaths in the top 30 countries representing 87% of global AIDS deaths. Eight countries accounted for 58% of the global AIDS deaths; Nigeria and South Africa accounted for 27% of global AIDS deaths. The highest death rates per 1000 people living with HIV were in Central African Republic (91), South Sudan (82), Côte d'Ivoire (75), Cameroon (72) and Chad (71), nearly 8-10 times higher than the high-income countries. ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively. Increasing ART coverage in these two countries to meet the proposed UN 90-90-90 Target by 2020 could avert 2.2 and 1.2 million deaths, respectively.

Interpretation: Over the past decade the expansion of access to ART averted millions of deaths. Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission. Despite progress, high-burden countries will need to accelerate access to ART treatment to avert millions of premature AIDS deaths and new HIV infections.

No MeSH data available.


Related in: MedlinePlus

Global AIDS-related death rate per 1000 people living with HIV in 2013.Map of AIDS death rate per 1000 people living with HIV for 2013 for 30 high AIDS mortality burden countries and eight high-income countries. UNAIDS AIDS-related deaths estimates for 2013 are not available for countries shown in grey. Countries in white were not included in analyses.
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pone.0131353.g002: Global AIDS-related death rate per 1000 people living with HIV in 2013.Map of AIDS death rate per 1000 people living with HIV for 2013 for 30 high AIDS mortality burden countries and eight high-income countries. UNAIDS AIDS-related deaths estimates for 2013 are not available for countries shown in grey. Countries in white were not included in analyses.

Mentions: Of the 30 countries with the highest AIDS-related death burden, Central African Republic (91 per 1000 people living with HIV), South Sudan (82 per 1000), Côte d’Ivoire (75 per 1000), Cameroon (72 per 1000) and Chad (71 per 1000) had the highest death rates (Table 1, Fig 2). The largest number of estimated AIDS-related deaths in 2013 was in Nigeria and South Africa; the death rate was 65 and 31 per 1000 people living with HIV, respectively. A comparison of death rates for selected high-, low- and middle-income countries demonstrates significant higher death rates in South Africa [31 per 1000] and Nigeria [65 per 1000] when compared with countries in North America and Europe (Fig 3). Additionally, between 2001 and 2013 the estimated annual death rate in Botswana decreased by 76% and approximates the rate for the United States. A number of countries achieved an “AIDS death to treatment tipping point” ratio of less than 1 whereby more people are put on ART than those estimated to be dying in a given year. Specifically, Angola, Haiti, India, Malawi, Mozambique, Myanmar, Namibia, Tanzania, Uganda, South Africa, Zambia, and Zimbabwe had surpassed the estimated annual number of deaths with reported number of people put on ART, with an “AIDS death to treatment tipping point” ratio of less than 1 (Table 1). Similarly, 12 of the 30 high-burden countries achieved the “new HIV infections to treatment tipping point” ratio of less than 1. But it is still very high in some countries (>3.5) including Malaysia, Indonesia, Cameroon, Côte d’Ivoire and South Sudan.


Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 1990-2013.

Granich R, Gupta S, Hersh B, Williams B, Montaner J, Young B, Zuniga JM - PLoS ONE (2015)

Global AIDS-related death rate per 1000 people living with HIV in 2013.Map of AIDS death rate per 1000 people living with HIV for 2013 for 30 high AIDS mortality burden countries and eight high-income countries. UNAIDS AIDS-related deaths estimates for 2013 are not available for countries shown in grey. Countries in white were not included in analyses.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493077&req=5

pone.0131353.g002: Global AIDS-related death rate per 1000 people living with HIV in 2013.Map of AIDS death rate per 1000 people living with HIV for 2013 for 30 high AIDS mortality burden countries and eight high-income countries. UNAIDS AIDS-related deaths estimates for 2013 are not available for countries shown in grey. Countries in white were not included in analyses.
Mentions: Of the 30 countries with the highest AIDS-related death burden, Central African Republic (91 per 1000 people living with HIV), South Sudan (82 per 1000), Côte d’Ivoire (75 per 1000), Cameroon (72 per 1000) and Chad (71 per 1000) had the highest death rates (Table 1, Fig 2). The largest number of estimated AIDS-related deaths in 2013 was in Nigeria and South Africa; the death rate was 65 and 31 per 1000 people living with HIV, respectively. A comparison of death rates for selected high-, low- and middle-income countries demonstrates significant higher death rates in South Africa [31 per 1000] and Nigeria [65 per 1000] when compared with countries in North America and Europe (Fig 3). Additionally, between 2001 and 2013 the estimated annual death rate in Botswana decreased by 76% and approximates the rate for the United States. A number of countries achieved an “AIDS death to treatment tipping point” ratio of less than 1 whereby more people are put on ART than those estimated to be dying in a given year. Specifically, Angola, Haiti, India, Malawi, Mozambique, Myanmar, Namibia, Tanzania, Uganda, South Africa, Zambia, and Zimbabwe had surpassed the estimated annual number of deaths with reported number of people put on ART, with an “AIDS death to treatment tipping point” ratio of less than 1 (Table 1). Similarly, 12 of the 30 high-burden countries achieved the “new HIV infections to treatment tipping point” ratio of less than 1. But it is still very high in some countries (>3.5) including Malaysia, Indonesia, Cameroon, Côte d’Ivoire and South Sudan.

Bottom Line: ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively.Over the past decade the expansion of access to ART averted millions of deaths.Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission.

View Article: PubMed Central - PubMed

Affiliation: International Association of Providers of AIDS Care, Washington D.C., United States of America.

ABSTRACT

Background: Antiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease progression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simulate four treatment scenarios for Nigeria and South Africa.

Methods: For 1990-2013, we used the Joint United Nations Programme on HIV/AIDS (UNAIDS) database to examine trends in AIDS deaths, HIV incidence and prevalence, ART coverage, annual AIDS death rate, AIDS death-to-treatment and HIV infections to treatment ratios for the top 30 countries with the highest AIDS mortality burden and compare them with data from high-income countries. We projected the 1990-2020 AIDS deaths for Nigeria and South Africa using four treatment scenarios: 1) no ART; 2) maintaining current ART coverage; 3) 90% ART coverage based on 2013 World Health Organization (WHO) ART guidelines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020.

Findings: In 2013, there were 1.3 million (1.1 million-1.6 million) AIDS deaths in the top 30 countries representing 87% of global AIDS deaths. Eight countries accounted for 58% of the global AIDS deaths; Nigeria and South Africa accounted for 27% of global AIDS deaths. The highest death rates per 1000 people living with HIV were in Central African Republic (91), South Sudan (82), Côte d'Ivoire (75), Cameroon (72) and Chad (71), nearly 8-10 times higher than the high-income countries. ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively. Increasing ART coverage in these two countries to meet the proposed UN 90-90-90 Target by 2020 could avert 2.2 and 1.2 million deaths, respectively.

Interpretation: Over the past decade the expansion of access to ART averted millions of deaths. Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission. Despite progress, high-burden countries will need to accelerate access to ART treatment to avert millions of premature AIDS deaths and new HIV infections.

No MeSH data available.


Related in: MedlinePlus