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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

Trends in estimated new infections, AIDS-related deaths and ART coverage in Nigeria and South Africa, 1990–2013.Trends with uncertainty bounds for new infections (red), AIDS-related deaths (blue), and ART coverage percentage (green), 1990 to 2013. ART coverage is calculated as the percentage of people reported on ART among the estimated people living with HIV for the same time period.
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pone.0131353.g004: Trends in estimated new infections, AIDS-related deaths and ART coverage in Nigeria and South Africa, 1990–2013.Trends with uncertainty bounds for new infections (red), AIDS-related deaths (blue), and ART coverage percentage (green), 1990 to 2013. ART coverage is calculated as the percentage of people reported on ART among the estimated people living with HIV for the same time period.

Mentions: Nigeria and South Africa account for 27% of the global HIV burden and have the highest AIDS-related death burden (Table 1). Fig 4plots the trends in AIDS-related deaths, new HIV infections, and ART coverage in Nigeria and South Africa from 1990–2013. After a peak in new HIV infections in 1999 in South Africa and 2000 in Nigeria, a declining trend has been observed in both countries. In 2000, new HIV infections in South Africa and Nigeria were 710,000 (670,000–760,000) and 360,000 (320,000–420,000), respectively, decreasing to 340,000 (310,000–370,000) and 220,000 (180,000–270,000) in 2013, respectively. While AIDS-related deaths peaked at 410,000 (380,000–440,000) in 2010 in South Africa, they have shown an increasing trend in Nigeria. From 2010–2013, South Africa has experienced a 52% decline in AIDS-related deaths while there was no decline in Nigeria. ART scale-up has progressed more slowly in Nigeria when compared to South Africa, especially between 2010 and 2013. In 2013, 42% (40%-44%) of the people living with HIV were on ART in South Africa, compared to ART coverage of 13% (12%-13%) in 2010. ART coverage in 2013 was 20% (18%-21%) in Nigeria, up from 11% (10%-12%) in 2010. South Africa has a new HIV infection to treatment ratio of 0.72 while Nigeria’s annual ratio is approximately 1.5 new HIV infections for each person placed on treatment.


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)

Trends in estimated new infections, AIDS-related deaths and ART coverage in Nigeria and South Africa, 1990–2013.Trends with uncertainty bounds for new infections (red), AIDS-related deaths (blue), and ART coverage percentage (green), 1990 to 2013. ART coverage is calculated as the percentage of people reported on ART among the estimated people living with HIV for the same time period.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0131353.g004: Trends in estimated new infections, AIDS-related deaths and ART coverage in Nigeria and South Africa, 1990–2013.Trends with uncertainty bounds for new infections (red), AIDS-related deaths (blue), and ART coverage percentage (green), 1990 to 2013. ART coverage is calculated as the percentage of people reported on ART among the estimated people living with HIV for the same time period.
Mentions: Nigeria and South Africa account for 27% of the global HIV burden and have the highest AIDS-related death burden (Table 1). Fig 4plots the trends in AIDS-related deaths, new HIV infections, and ART coverage in Nigeria and South Africa from 1990–2013. After a peak in new HIV infections in 1999 in South Africa and 2000 in Nigeria, a declining trend has been observed in both countries. In 2000, new HIV infections in South Africa and Nigeria were 710,000 (670,000–760,000) and 360,000 (320,000–420,000), respectively, decreasing to 340,000 (310,000–370,000) and 220,000 (180,000–270,000) in 2013, respectively. While AIDS-related deaths peaked at 410,000 (380,000–440,000) in 2010 in South Africa, they have shown an increasing trend in Nigeria. From 2010–2013, South Africa has experienced a 52% decline in AIDS-related deaths while there was no decline in Nigeria. ART scale-up has progressed more slowly in Nigeria when compared to South Africa, especially between 2010 and 2013. In 2013, 42% (40%-44%) of the people living with HIV were on ART in South Africa, compared to ART coverage of 13% (12%-13%) in 2010. ART coverage in 2013 was 20% (18%-21%) in Nigeria, up from 11% (10%-12%) in 2010. South Africa has a new HIV infection to treatment ratio of 0.72 while Nigeria’s annual ratio is approximately 1.5 new HIV infections for each person placed on treatment.

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