Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BackgroundSince the setting of the Millennium Development Goals in 2000, there have been increased efforts to tackle the global burden of HIV, tuberculosis and malaria. The recent release of data from the Global Burden of Disease (GBD) Study 2013 gives an opportunity to assess how far we have come in rolling back these three diseases.MethodThe Global Burden of Disease study collates and analyses various datasets to provide global estimates of disease prevalence. This study used data from the GBD Study 2013, which expands upon the methodology, datasets and tools covered in GBD Study 2010. In addition, this study used other data sources such as vital registration system data, verbal autopsy data, case notification data, prevalence surveys, cause of death data, and data from surveys of prevalence, drug resistance and coverage of insecticide-treated bednets. The authors used an adapted version of the UNAIDS Spectrum software model to estimate the incidence and mortality for HIV, cause of death ensemble modelling to estimate tuberculosis incidence and mortality, and an updated cause of death database to estimate incidence and mortality for malaria.Of note, Evidence for Action’s first Evidence Advisor contributed to this research.Key findings

• The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000 

HIV:

• Globally in 2013, there were 1.8 million new HIV infections and overall prevalence of the disease had risen to 29.2 million cases
• However in 2013, there were fewer deaths from HIV than in 2005 (1.3 million instead of 1.7 million)
• The number of new HIV infections in children more than halved from 340,000 in 2000 to 134,000 in 2013
• Through interventions including antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) of HIV, 19.1 million years of life have been saved globally
• In the 15-24 age group, there are generally more HIV infections in women than men
• This study found that its data did not match UNAIDS estimates – for example, it found the number of people living with HIV in 2012 was 6.6 million fewer than UNAIDS had estimated and the number of deaths from HIV in 2005 was 635,000 lower than UNAIDS’ figures. 

Tuberculosis:

• In 2013, the number of cases of tuberculosis was 7.5 million and number of deaths was 1.4 million
• However tuberculosis deaths have decreased globally since 1990, and the number of cases has decreased since 2000
• The authors also estimate higher mortality, lower prevalence, and a smaller number of tuberculosis cases related to HIV than the WHO estimates.

Malaria:

• Child deaths from malaria in sub-Saharan Africa have decreased by 31.5% between 2004 and 2013
• The study found that its estimate of the number of people living with malaria was higher than the World Health Organization (WHO) estimate.

ConclusionsThe authors conclude that substantial progress has occurred in fighting HIV, tuberculosis and malaria as the result of global action. However, HIV, tuberculosis, and malaria remain major health challenges in 2013. The authors also emphasise that they are not critiquing the estimates presented by organisations such as UNAIDS and WHO, merely presenting an alternate set of estimates based on a different statistical approach.You can access the article in full, alongside regional and country-specific estimates by clicking here.Murray, C.J. L., Ortblad, K. F., Guinovart, C., Lim, S. S., Wolock, T. M., Roberts, D. A. … Vos, T. (2014). Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9947), 1005-1070.