Tuesday, 7 April 2015

The global incidence of HIV, malaria and tuberculosis following the Millennium Declaration: what has been achieved?

Dr Katherine Gibney has co-authored a paper with numerous researchers, exploring the global regional and national incidence for HIV, malaria and tuberculosis through a systematic analysis for the Global Burden of Disease Study.

HIV, tuberculosis and malaria have been a public health priority given the impacts of such diseases in communities around the globe. The development of the Millennium Declaration (2000) has placed a spotlight on these infections, highlighting the need for further exploration and strategies to address the associated concerns.

This was achieved via the formation of Millennium Development Goal Six:

“Have halted by 2015 and begun to reverse the spread of HIV/AIDS”

“Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it”

“Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”

(Source: http://www.un.org/millenniumgoals/aids.shtml)

These goals have led to the development of organisations such as Global Fund to Fight AIDS, Tuberculosis and Malaria which focus on addressing the burden of these three communicable diseases and assisting in the efforts to reduce the prevalence of these infections. As a result, the investments in aiding these efforts saw a rise following 2000 till 2011 with a total of $51·6 billion for HIV, $8·3 billion for tuberculosis and $11·3 billion for malaria (US dollars) being devoted for the cause. However, the surge of non-communicable disease prevalence in several countries has created questions regarding the importance of prioritising communicable disease efforts with illnesses such as cardiovascular disease creating a double burden of disease in various communities.

Given these arguments, it is crucial to better understand the pattern of these infections since the conception of Millennium Development Six. The Global Burden of Disease Study is a vital source of information in comprehending the distribution and prevalence of these major diseases across several platforms. The annual report creates easy accessibility in understanding the pattern of infections across a longer period of time. Therefore, the intention of this paper is to determine whether the development of MDG Six has been effective in reducing the rates of HIV, tuberculosis and malaria via an analysis of the Global Burden of Disease Study 2013.

The researchers utilised the UNAIDS Spectrum Model to estimate the mortality and incidence of HIV. Counterfactual scenarios for HIV were used to determine the years of life saved via anti retro-viral therapy and the prevention of mother-to-child transmission of HIV. To assess tuberculosis, verbal autopsy data and vital registration were evaluated to determine mortality through the modelling of cause of death. Malaria incidence and mortality was measured via the use of a death database, a systematic analysis of verbal autopsy studies and the examination of studies from 2010-2013 which discussed drug-resistance and incidence.

The researchers estimate that in 2013, there were 1.8 million new HIV infections, 1.3 million HIV related deaths and 29.2 million prevalent cases. Furthermore, during 2005 (epidemic period), there were 1.7 million HIV related deaths. Via the implementation of anti-retroviral therapy and minimisation of mother-to-child transmission, 19.1 million life years have been saved in developing areas. Tuberculosis incidence in 2013 was estimated to be 7.5 million with prevalence of 11.9 million and number of deaths being estimated as 1.4 million. Deaths and the number of cases due to malaria rose between 1990 and 2004 with 232 million cases in 2003 and 1.2 million deaths in 2004. However, since then, death due to malaria in children has dropped by 31.5%. Additionally, in countries outside of Africa, mortality rates have seen a decline since 1990.

The researchers conclude that their estimates of the number of HIV positive individuals are 18.7% lesser than the UNAIDS estimates from 2012. In addition, the rates of individuals with malaria are higher than the World Health Organisation estimate. They close that the incidence rates for all three diseases have seen a decline since 2000. Whilst there has been improvement through the formation of the Millennium Declaration, 101 countries still have growing rates of HIV incidence, indicating a need for renewed efforts to address the burden of HIV in several communities. However, it is recognised that the development of the Millennium Declaration and associated organisations to tackle these three diseases have seen success in various populations. 

Read the full paper here:

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