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The burden of the global HIV epidemic is disproportionate
falling on lower prevalence countries, according to an badysis published in
the Journal of Virus Eradication. the
most new HIV infections, cases of HIV transmission from mother to child and
AIDS-related deaths are now occurring in countries where HIV prevalence is less than 4.5%.
Low-prevalence countries also had lower rates of antiretroviral therapy (ART)
coverage and early diagnosis of the infant.
The authors note that international donors
such as PEPFAR (President's Emergency Plan for AIDS Relief) and
Global Fund targets its resources on countries most affected by HIV
prevalence. PEPFAR currently has 13 priority countries. Can targets for the
Can HIV control be achieved if lower prevalence countries are neglected?
"The international community has galvanized
large funds and field actions in high-prevalence countries,
that could be replicated with political will in the lowest prevalence countries, "the authors say.
They used information from UNAIDSinfo
database for 2017 to compare several key indicators of the HIV epidemic
depending on whether countries had high or low HIV prevalence (higher / lower than
4.5%). Just under half of the HIV-positive population in the world lives in countries
with a prevalence below this threshold.
Countries of North America, Oceania and the West
Europe has been excluded from the badysis. A total of 56 countries, all HIV positive
outbreaks of 40,000 cases or more were included. These countries represent 88%
the global HIV epidemic, 87% of new infections worldwide and 89% of all
Deaths related to AIDS.
There were twelve countries with high prevalence
with a total of 16.7 million people living with HIV (PLHIV) and 44 patients with lower prevalence
counties with 15.1 million PLWHA. While all high prevalence countries have been
in sub-Saharan Africa, only about half of the lower prevalence countries were.
There were 4.1 new infections per 100 PLHIV in high prevalence countries, compared
5.8 per 100 PLHIV in low prevalence countries.
Adult
ART cover was higher in
high prevalence countries compared to low prevalence countries (67% vs. 47%). As prevalence decreased,
the same was true for antiretroviral coverage (p = 0.00325).
There was less AIDS-related deaths in high-prevalence countries compared to low-prevalence countries (306,100
530,000).
Coverage of interventions to prevent mother-to-child transmission
(PMTCT) decreased with decreasing national HIV prevalence (p = 0.028). Blanket
was 91% among pregnant women living in high-prevalence countries, compared to 53%
in countries with lower prevalence.
The rate of HIV transmission from mother to child in high and low prevalence
8% and 17%, respectively. While three of the lower prevalence countries
has a maternal-to-child transmission rate of less than 10% (Rwanda, Brazil and
Argentina), almost half of the low-prevalence countries had a transmission rate
at least 20%, including Nigeria at 23%. Nearly two-thirds (61%) of
171,000 new childhood infections recorded in 2017 occurred with a lower prevalence
countries.
Early
infant diagnosis Rate (EID)
also increased with national prevalence (p = 0.027). Average rates of EID among
and the lowest prevalence countries were 71% and 30% respectively.
ART
blanket for children increases
as prevalence increased, averaging 64% for high-prevalence countries
against 29% for lower prevalence countries. AIDS-related deaths were less frequent in high prevalence countries
(4% of children with HIV) than in low prevalence countries (8%).
"Several strategies are used in
higher prevalence parameters that could potentially be applied in
low prevalence, including the decentralization of health systems, the task of
changing, distribution of ART by community health workers and mobile technology,
membership, support networks and the adoption of WHO guidelines for testing and
treat, comment the authors.
Some lower prevalence countries had good
with Ethiopia, the Democratic Republic of the Congo and Rwanda, all
showing that improvements in early diagnosis rates and coverage of antiretroviral therapy are
possible.
However, they note that the lower prevalence
countries can face particular challenges in reaching key populations. Such
countries often have unique epidemiological, technological and social characteristics.
challenges posed by the provision of ART.
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