Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990-2017
Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990-2017
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DOI：
10.1186/s12889-020-08988-9
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发表时间：
2020-06-05
影响因子：
4.5
通讯作者：
Mokdad, Ali H.
中科院分区：
文献类型：
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作者：
Gona, Philimon N.;Gona, Clara M.;Mokdad, Ali H.
背景南部非洲发展共同体(南共体)16个国家仍然是艾滋病毒/艾滋病流行的中心，感染艾滋病毒/艾滋病的人数最多。抗逆转录病毒治疗(ART)提高了存活率，防止了艾滋病毒的母婴传播，但这种疾病仍然是严重的死亡原因。我们使用全球疾病、伤害和风险因素负担(GBD)研究的次要数据，对16个南共体国家的艾滋病毒/艾滋病负担进行了描述性流行病学分析。方法GBD研究是健康指标与评估研究所(IHME)的系统、科学努力，以量化特定时间点因疾病、伤害和风险因素造成的相对健康损失的大小。我们分析了以下结果：南部非洲发展共同体因艾滋病毒/艾滋病造成的死亡率、减寿年数(YLLS)、残疾生活年数(YLDs)和残疾调整寿命年(DALY)。GBD的输入数据来自人口普查、家庭调查、民事登记和生命统计、疾病登记、卫生服务利用、疾病通报和其他来源。使用死因集合模型(CODEm)和时空高斯过程回归(ST-GPR)计算特定国家和特定原因的艾滋病毒/艾滋病相关死亡率。死亡率乘以每个年龄组的标准预期寿命，以计算YLLS。使用贝叶斯元回归建模工具DisMod-MR估计特定死因死亡率。患病率估计乘以疾病后遗症的残疾权重，以计算年死亡率。确定了每个国家每10万人口的粗率和年龄调整率以及1990至2017年间的变化。结果2017年，艾滋病毒/艾滋病在南共体国家造成336,175人死亡，2000多万人死亡。这相当于1990年死亡人数为113,631人(6915,170人)的3倍。2017年可归因于艾滋病毒/艾滋病死亡的五个主要国家是博茨瓦纳，28.7%(95%UI；23.7-35.2)，其次是南非28.5%(25.8-31.6)，莱索托，25.1%(21.2-30.4)，埃斯瓦蒂尼24.8%(21.3-28.6)，莫桑比克24.2%(20.6-29.3)。这五个国家的相对可归因性死亡人数至少是全球负担1.7%(1.6-1.8)的14倍。YLD、YLLS和DALY也观察到了类似的模式。科摩罗、塞舌尔和毛里求斯处于较低水平，归属比例不到1%，低于全球比例。结论自艾滋病毒/艾滋病负担高峰期以来，在减轻艾滋病毒/艾滋病负担方面取得了很大进展，但需要做更多的工作。2005年后的下降归因于预防艾滋病毒母婴传播、通过美国总统艾滋病紧急救济计划(PEPFAR)提供的资源以及行为变化。按艾滋病毒/艾滋病死亡比例和年龄标化死亡率衡量，艾滋病毒/艾滋病负担最重的五个国家是博茨瓦纳、南非、莱索托、埃斯瓦蒂尼和莫桑比克。南共体国家应该合作，与捐助者合作，并接受联合国快车道方法，该方法呼吁从国内或其他来源进行前期投资，以预防和治疗艾滋病毒/艾滋病。需要进行强有力的跟踪、检测和早期治疗，并完善针对该区域暂住人口的个别治疗策略。
BackgroundThe 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study.MethodsThe GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country.ResultsIn 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7-35.2), followed by South Africa 28.5% (25.8-31.6), Lesotho, 25.1% (21.2-30.4), eSwatini 24.8% (21.3-28.6), and Mozambique 24.2% (20.6-29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6-1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion.ConclusionsGreat progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President's Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.