Most new HIV infections, vertical transmissions and AIDS-related deaths occur in lower-prevalence countries

Author List
Joe Kempton
Andrew Hill
Jacob A Levi
Katherine Heath
Anton Pozniak

Abstract

Objectives: The Joint United Nations Programme on HI V/AI DS (UNAI DS) targets aim to reduce new HI V infections below 500,000 per year by 2020. Despite targeted prevention programmes, total new infections remained in 2016 and 2017 at 1,800,000 cases. We have aimed to analyse data from 2017 and to compare HI V incidence, AI DS-related deaths and provision of antiretroviral therapy (AR T) to adults, pregnant women and children living with HI V in lower- and higher-prevalence countries. Mother-to-child transmission (MTCT) and early infant diagnosis (EI D) rates were also investigated. Methods: UNAI DSinfo data use the Spectrum model to represent country-level HI V data. Countries with epidemics over 40,000 HI V cases were separated into higher prevalence (≥4.5%) and lower prevalence (<4.5%). Least squares linear regression, weighted by epidemic size and controlled for gross domestic product/capita, was used to compare HI V prevalence with estimated AR T coverage in adults (≥15 years), children (0–14 years), pregnant women, and EI D rates and MTCT rates. Data were then compared between higher- and lower-prevalence groups, including numbers of new HI V infections and AI DS-related deaths. Results: Data were available for 56 countries. Twelve higher-prevalence countries accounted for 16.7 million and 44 lower-prevalence ones for 15.1 million people living with HI V, altogether making up 87.5% of the global estimate. Lower-prevalence countries had less AR T coverage for adults, pregnant women and children, lower EI D rates and higher AI DS-related death levels. There were more new HI V infections in adults and children in lower- than higher-prevalence countries. Conclusions: Most new HI V infections, MTCTs and AI DS-related deaths occurred in countries with an HI V prevalence rate below 4.5%. Many of these countries are not targeted by access programmes, such as the President’ Emergency Plan for AI DS Relief. More intensive programmes of diagnosis and treatment are needed in these countries in the effort to reduce global new HI V infections below 500,000 per year by 2020.

Article Category

HIV cure research

Article Type

Original research

Posted Date

09-04-2019

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