Most comprehensive study on HIV, malaria, TB shows major progress in the millennium

Funding and policy have had real impact in combating the diseases, although challenges remain

By Moushumi Sharma
Published: Thursday 24 July 2014

India, Nigeria and Democratic Republic of Congo account for roughly half of all malaria deaths (Photo: Centres for Disease Control and Prevention)Accelerated progress against HIV, malaria and tuberculosis (TB) has been made worldwide since 2000 when world governments adopted the Millennium Development Goal (MDG) 6 to combat these diseases, says a study published in The Lancet. The new estimates from an analysis of the Global Burden of Disease Study 2013 show that the HIV epidemic is smaller than previously thought. At the same time, the global burden of malaria could be larger than recent WHO estimates.

“We have seen a huge increase in both funding and policy attention given to HIV/AIDS, malaria and TB over the past 13 years, and our findings show that a focus on these specific diseases has had a real impact. However, much remains to be done and all three diseases continue to be major health challenges,” The Lancet quotes lead author Christopher Murray, professor of global health at the University of Washington, the US. Murray and an international team of researchers used data from all available sources, including vital registration systems and verbal autopsy data to track the global, regional and national incidence, prevalence and premature deaths caused by HIV, malaria and TB for 188 countries between 1990 and 2013.

According to their study, which was funded by the Bill & Melinda Gates Foundation, 1.8 million people are newly infected with HIV each year, with the number of people living with HIV rising to 29 million in 2012. However, HIV-related deaths have fallen substantially over the years. At the peak of the epidemic in 2005, HIV caused 1.7 million deaths worldwide. This came down to 1.3 million in 2013. The study says that antiretroviral therapy has saved around 19.1 million life-years since 1996—5.7 million in developed countries and 13.4 million in developing countries.

The researchers say that the overall progress for TB looks promising. The number of TB deaths was reduced from 1.6 million in 2000 to 1.4 million in 2013. There have been faster rates of decline in the incidence of TB in 12 regions of the world, compared with the decade before the adoption of MDG. However, the number of people living with TB worldwide has increased from 8.5 million in 1990 to 12 million in 2013. According to the study, the TB burden is most evident in south and southeast Asia.

The data says that malaria is killing more people than previously estimated, although the number of deaths has fallen since 2004. While global malaria incidence peaked in 2003, with 232 million new cases, it fell to 165 million cases in 2013. Although there has been considerable progress in combating malaria in most regions of the world, incidence continues to be high in countries such as India, Nigeria, Mozambique and Democratic Republic of Congo. Barring Mozambique, the three countries account for roughly half of all malaria deaths.

According to Murray, estimates of the global burden of HIV, malaria and TB are crucial elements of the effort to control these diseases. “What is clear from our analysis is how little we reliably know in many countries to track progress. Rapidly reducing the massive uncertainty that surrounds the measurement of these diseases, particularly malaria, will be essential if we are to better monitor, and respond to, evidence about progress,” he told The Lancet.

The research paper was presented at the ongoing 20th international AIDS conference in Melbourne, Australia.

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