Objectives

The Joint United Nations Programme on HIV/AIDS (UNAIDS) targets aim to reduce new HIV 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 HIV incidence, AIDS-related deaths and provision of antiretroviral therapy (ART) to adults, pregnant women and children living with HIV in lower- and higher-prevalence countries. Vertical or mother-to-child transmission (MTCT) and early infant diagnosis (EID) rates were also investigated.

Methods

UNAIDSinfo data use the Spectrum model to represent country-level HIV data. Countries with epidemics over 40,000 HIV 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 HIV prevalence with estimated ART coverage in adults (≥15 years), children (0–14 years), pregnant women, and EID rates and MTCT rates. Data were then compared between higher- and lower-prevalence groups, including numbers of new HIV infections and AIDS-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 HIV, altogether making up 87.5% of the global estimate. Lower-prevalence countries had less ART coverage for adults, pregnant women and children, lower EID rates and higher AIDS-related death levels. There were more new HIV infections in adults and children in lower- than higher-prevalence countries.

Conclusions

Most new HIV infections, MTCTs and AIDS-related deaths occurred in countries with an HIV prevalence rate below 4.5%. Many of these countries are not targeted by access programmes, such as the President’ Emergency Plan for AIDS Relief. More intensive programmes of diagnosis and treatment are needed in these countries in the effort to reduce global new HIV infections below 500,000 per year by 2020.

中文翻译：

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大多数新的艾滋病毒感染，垂直传播和与艾滋病相关的死亡发生在低流行国家

目标

联合国艾滋病毒/艾滋病联合规划署（艾滋病规划署）的目标是到2020年将每年的新的艾滋病毒感染减少到500,000以下。尽管有针对性的预防方案，2016年和2017年的新感染总数仍为1,800,000例。我们旨在分析2017年以来的数据，并比较低和高患病率国家中成年人，孕妇和儿童的艾滋病毒感染率，与艾滋病相关的死亡以及提供抗逆转录病毒疗法（ART）。垂直或母婴传播（MTCT）和早期婴儿诊断（EID）率也进行了调查。

方法

UNAIDSinfo数据使用“光谱”模型表示国家一级的HIV数据。流行病超过40,000例的国家被划分为较高的患病率（≥4.5％）和较低的患病率（<4.5％）。最小二乘线性回归，按流行病大小加权，并控制了国内生产总值/人均，用于比较成人（≥15岁），儿童（0-14岁），孕妇（和孕妇）的HIV感染率与估计的ART覆盖率和MTCT费率。然后比较了较高和较低患病率人群之间的数据，包括新感染艾滋病毒的人数和与艾滋病相关的死亡。

结果

有56个国家的数据。十二个高流行国家占1,670万，44个低流行国家占1,510万艾滋病毒感染者，占全球估计数的87.5％。患病率较低的国家对成人，孕妇和儿童的抗逆转录病毒疗法覆盖率较低，EID率较低，与艾滋病相关的死亡率更高。低流行国家的成年人和儿童中新感染艾滋病毒的人数更多。

结论

大多数新的艾滋病毒感染，MTCT和与艾滋病有关的死亡发生在艾滋病毒流行率低于4.5％的国家。在这些国家中，有许多国家并未受到诸如艾滋病防治总统紧急计划之类的准入计划的打击。这些国家需要更深入的诊断和治疗计划，以期到2020年将全球每年新增的HIV感染减少到50万以下。