The University of Southampton
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Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015
Background: timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.

Methods: for countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.

Findings: global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.

Interpretation: scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
Funding

Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health
2352-3018
e361-e387
Wang, Haidong
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Wolock, Tim M
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Carter, Austin
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Nguyen, Grant
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Gakidou, Emmanuela
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Hay, Simon I
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Mills, Edward J
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Trickey, Adam
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Msemburi, William
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Coates, Matthew M
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Mooney, Meghan D
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Fraser, Maya S
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Zeeb, Hajo
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Zhang, Hao
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Zhao, Yong
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Zodpey, Sanjay
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Zoeckler, Leo
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Zuhlke, Liesl Joanna
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Lopez, Alan D
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Murray, Christopher J L
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Tsilimparis, Nikolaos, Tura, Abera Kenay, Ukwaja, Kingsley Nnanna, Uneke, Chigozie Jesse, Uthman, Olalekan A, Venketasubramanian, N, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wang, Linhong, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, Wijeratne, Tissa, Wilkinson, James D, Wiysonge, Charles Shey, Wolfe, Charles D A, Won, Sungho, Wong, John Q, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yano, Yuichiro, Yaseri, Mehdi, Yebyo, Henock Gebremedhin, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Yu, Shicheng, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zeeb, Hajo, Zhang, Hao, Zhao, Yong, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, Lopez, Alan D and Murray, Christopher J L (2016) Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV, 3 (8), e361-e387. (doi:10.1016/S2352-3018(16)30087-X). (PMID:27470028)

Record type: Article

Abstract

Background: timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.

Methods: for countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.

Findings: global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.

Interpretation: scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
Funding

Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health

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Accepted/In Press date: 19 July 2016
e-pub ahead of print date: 19 July 2016
Published date: August 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 398750
URI: http://eprints.soton.ac.uk/id/eprint/398750
ISSN: 2352-3018
PURE UUID: 8f18d7ed-df33-46b2-8421-75f210deaf67
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 01 Aug 2016 12:48
Last modified: 07 Oct 2020 01:40

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Author: Haidong Wang
Author: Tim M Wolock
Author: Austin Carter
Author: Grant Nguyen
Author: Hmwe Hmwe Kyu
Author: Emmanuela Gakidou
Author: Simon I Hay
Author: Edward J Mills
Author: Adam Trickey
Author: William Msemburi
Author: Matthew M Coates
Author: Meghan D Mooney
Author: Maya S Fraser
Author: Amber Sligar
Author: Joshua Salomon
Author: Heidi J Larson
Author: Joseph Friedman
Author: Amanuel Alemu Abajobir
Author: Kalkidan Hassen Abate
Author: Kaja M Abbas
Author: Mohamed Magdy Abd El Razek
Author: Foad Abd-Allah
Author: Abdishakur M Abdulle
Author: Semaw Ferede Abera
Author: Ibrahim Abubakar
Author: Laith J Abu-Raddad
Author: Niveen M E Abu-Rmeileh
Author: Gebre Yitayih Abyu
Author: Akindele Olupelumi Adebiyi
Author: Isaac Akinkunmi Adedeji
Author: Ademola Lukman Adelekan
Author: Koranteng Adofo
Author: Arsène Kouablan Adou
Author: Oluremi N Ajala
Author: Tomi F Akinyemiju
Author: Nadia Akseer
Author: Faris Hasan Al Lami
Author: Ziyad Al-Aly
Author: Khurshid Alam
Author: Noore K M Alam
Author: Deena Alasfoor
Author: Saleh Fahed S Aldhahri
Author: Robert William Aldridge
Author: Miguel Angel Alegretti
Author: Alicia V Aleman
Author: Zewdie Aderaw Alemu
Author: Rafael Alfonso-Cristancho
Author: Raghib Ali
Author: Ala'a Alkerwi
Author: François Alla
Author: Rajaa Mohammad
Author: Salem Al-Raddadi
Author: Ubai Alsharif
Author: Elena Alvarez
Author: Nelson Alvis-Guzman
Author: Azmeraw T Amare
Author: Alemayehu Amberbir
Author: Adeladza Kofi Amegah
Author: Walid Ammar
Author: Stephen Marc Amrock
Author: Carl Abelardo T Antonio
Author: Palwasha Anwari
Author: Johan Ärnlöv
Author: Al Artaman
Author: Hamid Asayesh
Author: Rana Jawad Asghar
Author: Reza Assadi
Author: Suleman Atique
Author: Lydia S Atkins
Author: Euripide Frinel G Arthur Avokpaho
Author: Ashish Awasthi
Author: Beatriz Paulina Ayala Quintanilla
Author: Umar Bacha
Author: Alaa Badawi
Author: Aleksandra Barac
Author: Till Bärnighausen
Author: Arindam Basu
Author: Tigist Assefa Bayou
Author: Yibeltal Tebekaw Bayou
Author: Shahrzad Bazargan-Hejazi
Author: Justin Beardsley
Author: Neeraj Bedi
Author: Derrick A Bennett
Author: Isabela M Bensenor
Author: Balem Demtsu Betsu
Author: Addisu Shunu Beyene
Author: Eesh Bhatia
Author: Zulfiqar A Bhutta
Author: Sibhatu Biadgilign
Author: Boris Bikbov
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Author: Michael Brainin
Author: Alexandra Brazinova
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Author: Alexandria Brown
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Author: Julio Cesar Campuzano
Author: Rosario Cárdenas
Author: Juan Jesus Carrero
Author: Carlos A Castañeda-Orjuela
Author: Jacqueline Castillo Rivas
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Author: Hsing-Yi Chang
Author: Jung-Chen Chang
Author: Laxmikant Chavan
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Author: Peggy Pei-Chia Chiang
Author: Mirriam Chibalabala
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Author: Jee-Young Jasmine Choi
Author: Devasahayam Jesudas Christopher
Author: Liliana G Ciobanu
Author: Tukur Dahiru
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Author: Cyrus Cooper ORCID iD
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