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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

The Lancet HIV. 2016. Vol. 3. No. 8. P. e361-e387.

Timely assessment of HIV/AIDS burden is essential for policy-setting and program evaluation. Based on
the Global Burden of Disease study 2015 (GBD 2015), we provide national estimates of levels and trends
of HIV/AIDS incidence, prevalence, ART coverage and mortality for 195 countries and territories from
1980 to 2015.
For countries without high quality vital registration data, we estimated prevalence and incidence from
antenatal clinic data and population-based sero-prevalence surveys and assumptions by age and sex on
initial CD4 distribution at infection, CD4 progression rates, on and off antiretroviral therapy mortality
(ART), 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. Estimation of
incidence, prevalence and death uses GBD versions of the EPP and Spectrum software originally
developed by UNAIDS. These versions have been recoded for speed and use 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 due to HIV recorded in cause of death statistics.
Cause of death statistics have been corrected for garbage coding and HIV misclassification.
Globally, HIV incidence reached its peak in 1997 at 3.3 million. Annual incidence has stayed relatively
constant at about 2.5 million since 2005 after a period of faster decline between 1997 and 2005. The
number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million in 2015. At
the same time, mortality due to HIV/AIDS has been declining at a steady pace from its peak at 1.8
million deaths in 2005 to 1.2 million deaths in 2015. There is substantial heterogeneity in the levels and
trends of HIV/AIDS across countries. While success stories can be found in many countries with
improved mortality due to HIV/AIDS and declines in annual new infections, slowdowns or increases in
rate of change in annual new infections has been observed elsewhere.

The global scale-up of ART and PMTCT has been one of the great successes of global health in the last
two decades. In the last decade, progress reducing new infections has been very slow, development
assistance for health devoted to HIV has stagnated, and low-income country resources for health have
grown slowly. New ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-
90 UNAIDS targets will be hard to achieve