Insights From the Global Burden of Disease Study 2010
Katrina F. Ortblad, Rafael Lozano, Christopher J.L. Murray
Abstract and Introduction
Objectives: To evaluate the global and country-level burden of HIV/AIDS relative to 291 other causes of disease burden from 1980 to 2010 using the Global Burden of Disease Study 2010 (GBD 2010) as the vehicle for exploration.
Methods: HIV/AIDS burden estimates were derived elsewhere as a part of GBD 2010, a comprehensive assessment of the magnitude of 291 diseases and injuries from 1990 to 2010 for 187 countries. In GBD 2010, disability-adjusted life years (DALYs) are used as the measurement of disease burden. DALY estimates for HIV/AIDS come from UNAIDS' 2012 prevalence and mortality estimates, GBD 2010 disability weights and mortality estimates derived from quality vital registration data.
Results: Despite recent declines in global HIV/AIDS mortality, HIV/AIDS was still the fifth leading cause of global DALYs in 2010. The distribution of HIV/AIDS burden is not equal across demographics and regions. In 2010, HIV/AIDS was ranked as the leading DALY cause for ages 30–44 years in both sexes and for 21 countries that fall into four distinctive blocks: Eastern and Southern Africa, Central Africa, the Caribbean and Thailand. Although a majority of the DALYs caused by HIV/AIDS are in high-burden countries, 20% of the global HIV/AIDS burden in 2010 was in countries where HIV/AIDS did not make the top 10 leading causes of burden.
Conclusion: In the midst of a global economic recession, tracking the magnitude of the HIV/AIDS epidemic and its importance relative to other diseases and injuries is critical to effectively allocating limited resources and maintaining funding for effective HIV/AIDS interventions and treatments.
In the last 30 years, the HIV/AIDS epidemic has emerged as one of the major challenges for the world, going from a relatively small problem in the 1980s to one of the leading causes of mortality and burden over the last decade.[1–3] The global trend is towards a larger and larger share of disease burden coming from noncommunicable diseases and injuries; however, HIV/AIDS is a dramatic exception.[2–4] Mortality and burden from HIV/AIDS increased steadily until around 2004, against the general trend of declining infectious disease burden. The HIV/AIDS epidemic has been truly global with 186 countries reporting HIV cases or deaths in 2012.[5,6]
Substantial concerted global action has emerged around the HIV/AIDS epidemic. New institutions have been formed: UNAIDS in 1996 and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as well as the US President's Emergency Plan for AIDS Relief (PEPFAR) in 2002.[8,9] These new global actors with substantial commitments to HIV/AIDS have been, along with many other nongovernmental programmes, key in raising national policy awareness in many affected countries and in scaling up access to antiretroviral therapies (ARTs).[10,11] In 2011, eight million HIV-positive people received ARTs (a 20-fold increase since 2003), translating into 54% of all eligible people in low and middle-income countries. Expansion of ART coverage is likely to have contributed to the reversal of the global trend in HIV/AIDS mortality. Successful scale-up of ARTs and the progress in reducing HIV/AIDS mortality have sparked excitement in the global community, and ambitious goals have followed. In 2011, UNAIDS released its 'Getting to Zero' campaign with a vision that entails a future generation with 'zero new HIV infections, zero discrimination and zero AIDS-related deaths'.[13,14]
Many factors have contributed to the achievements of the global response to the epidemic; new financial resources are likely to have been critical. Between 2002 and 2010, development assistance for health (DAH) targeted for HIV/AIDS increased from US$1.4 billion to US$6.8 billion (385.7%); and this does not include the substantial funds spent by low- and middle-income countries themselves. Since 2010, however, levels of DAH have stagnated, as the long-run effects of the global financial crisis become apparent in the budgets of high-income countries. Because of the success of ART programmes and the continued evolution of the epidemic, the numbers of individuals who need ARTs will continue to rise steadily. Increasing need for resources for HIV/AIDS programmes in the context of flat-line budgets is also happening in parallel with renewed attention to other health problems such as child mortality, maternal mortality and more recently noncommunicable diseases.
Maintaining and expanding the response to the HIV/AIDS epidemic will require continued emphasis on quantifying the magnitude of the impact of the epidemic in each country. UNAIDS and the WHO provide bi-annual assessments of the epidemic in terms of incidence of new infections, the prevalence of people living with HIV and deaths from HIV/AIDS for the vast majority of countries.[5,16–18] These analyses have been invaluable in garnering policy attention and response. The financial needs of HIV/AIDS programmes during a period of stagnant DAH levels highlight the importance of tracking the HIV/AIDS epidemic in the context of other health problems. At the national level, understanding the importance of the HIV/AIDS epidemic and its trends is facilitated by measuring the burden of disease in units that allow comparison with other major conditions. Comparable metrics of disease burden provide much-needed information on where the epidemic remains one of the dominant causes of health loss and where the burden is still rising despite progress in many countries.
The Global Burden of Disease Study 2010 (GBD 2010)[1–3,20–25] provides a comprehensive coherent view of the magnitude of 291 diseases and injuries from 1990 to 2010 for 187 countries. GBD 2010 uses a consistent set of definitions, approaches to data and methods to quantify health loss from all these diseases and injuries. Multiple metrics are used to compare conditions, including death numbers, age-specific mortality rates, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs are a summation of YLLs and YLDs and serve as an overall metric of disease burden. In this study, we use GBD 2010 to understand the magnitude of the HIV/AIDS epidemic at the national level, in the context of all other major health problems, and how it has been changing over the last two decades.