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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

Projected estimated deaths averted by ART coverage scenarios for South Africa and Nigeria, 1990–2020.Projected deaths averted by ART expansion scenarios for South Africa and Nigeria. Reference baseline is projected deaths in the absence of ART (No ART scenario) which is compared to 1) maintenance of current ART coverage levels till 2020 (Current ART Coverage scenario); 2) expansion of access to 90% ART coverage rates of people eligible under WHO 2013 guidelines by 2020 (2013 WHO Guidelines scenario) and 3) UNAIDS “90-90-90” target or 81% of people living with HIV on ART by 2020 (90-90-90 Scenario). The estimated deaths averted represent the total difference from the No ART scenario.
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pone.0131353.g005: Projected estimated deaths averted by ART coverage scenarios for South Africa and Nigeria, 1990–2020.Projected deaths averted by ART expansion scenarios for South Africa and Nigeria. Reference baseline is projected deaths in the absence of ART (No ART scenario) which is compared to 1) maintenance of current ART coverage levels till 2020 (Current ART Coverage scenario); 2) expansion of access to 90% ART coverage rates of people eligible under WHO 2013 guidelines by 2020 (2013 WHO Guidelines scenario) and 3) UNAIDS “90-90-90” target or 81% of people living with HIV on ART by 2020 (90-90-90 Scenario). The estimated deaths averted represent the total difference from the No ART scenario.

Mentions: Between 1990 and 2013, ART has averted nearly 1 million and 0.4 million AIDS-related deaths in South Africa and Nigeria, respectively. A projection of estimated deaths in the Current ART Coverage Scenario suggests that maintaining the current levels of ART coverage through 2020 would avert 1.3 and 0.5 million deaths between 2014 and 2020 for South Africa and Nigeria, respectively, compared to the No ART Scenario (Fig 5). Compared to the Current ART Coverage Scenario, increasing ART coverage to the reach the UN 90-90-90 Target (i.e. 90-90-90 Scenario) would avert an estimated 2.2 million and 1.2 million deaths for South Africa and Nigeria, respectively. The projections for 2020 suggest that the 90-90-90 Scenario averts a similar number of deaths as the 2013 WHO Guidelines Scenario (90% ART coverage among those people who are eligible for ART by 2020).


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)

Projected estimated deaths averted by ART coverage scenarios for South Africa and Nigeria, 1990–2020.Projected deaths averted by ART expansion scenarios for South Africa and Nigeria. Reference baseline is projected deaths in the absence of ART (No ART scenario) which is compared to 1) maintenance of current ART coverage levels till 2020 (Current ART Coverage scenario); 2) expansion of access to 90% ART coverage rates of people eligible under WHO 2013 guidelines by 2020 (2013 WHO Guidelines scenario) and 3) UNAIDS “90-90-90” target or 81% of people living with HIV on ART by 2020 (90-90-90 Scenario). The estimated deaths averted represent the total difference from the No ART scenario.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0131353.g005: Projected estimated deaths averted by ART coverage scenarios for South Africa and Nigeria, 1990–2020.Projected deaths averted by ART expansion scenarios for South Africa and Nigeria. Reference baseline is projected deaths in the absence of ART (No ART scenario) which is compared to 1) maintenance of current ART coverage levels till 2020 (Current ART Coverage scenario); 2) expansion of access to 90% ART coverage rates of people eligible under WHO 2013 guidelines by 2020 (2013 WHO Guidelines scenario) and 3) UNAIDS “90-90-90” target or 81% of people living with HIV on ART by 2020 (90-90-90 Scenario). The estimated deaths averted represent the total difference from the No ART scenario.
Mentions: Between 1990 and 2013, ART has averted nearly 1 million and 0.4 million AIDS-related deaths in South Africa and Nigeria, respectively. A projection of estimated deaths in the Current ART Coverage Scenario suggests that maintaining the current levels of ART coverage through 2020 would avert 1.3 and 0.5 million deaths between 2014 and 2020 for South Africa and Nigeria, respectively, compared to the No ART Scenario (Fig 5). Compared to the Current ART Coverage Scenario, increasing ART coverage to the reach the UN 90-90-90 Target (i.e. 90-90-90 Scenario) would avert an estimated 2.2 million and 1.2 million deaths for South Africa and Nigeria, respectively. The projections for 2020 suggest that the 90-90-90 Scenario averts a similar number of deaths as the 2013 WHO Guidelines Scenario (90% ART coverage among those people who are eligible for ART by 2020).

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