HIV AIDS State of the Epidemic HIV AIDS State

Reviews
Shared by: Piece Piece
Stats
views:
70
rating:
not rated
reviews:
0
posted:
2/26/2009
language:
English
pages:
0
HIV/AIDS – State of the Epidemic HIV/AIDS – State of the Epidemic Kevin M. De Cock, MD World Health Organization IAS-USA, March 14, 2008 • Global estimates and measurement • Epidemiologic parameters and their interpretation • Descriptive epidemiology by region • Descriptive epidemiology – United States • Determinants of heterogeneity • Responding to HIV/AIDS • Apologies for too many slides The Cycle of HIV Disease 1. Incidence of HIV Infection 2. Prevalence of HIV Infection 3. Incidence AIDS 4. Prevalence of AIDS 5. Mortality from AIDS Global Distribution of HIV Infections Sub-Saharan Africa Asia The Americas Europe North Africa, ME Oceania 68% 14% 11% 7% 1% <1% Estimated adult (15–49 years) HIV prevalence rate (%) globally and in Sub-Saharan Africa, 1990–2007 8 7 6 Adult HIV 4 preval ence (%) Sub-Saharan Africa 5 3 2 1 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Global Year 1 Estimated number of people living with HIV globally, 1990–2007 Estimated number of people newly infected with HIV globally, 1990–2007 Millions 6 5 4 Million 40 30 Number of people 20 living with HIV 10 0 199019911992199319941995199619971998199920002001200220032004200520062007 Number of people newly infected with HIV Upper range 3 Estimate 2 Lower range 1 0 1990 1991 1992 1993 19941995 1996 1997 1998 19992000 2001 2002 2003 2004 2005 2006 2007 Year Year This bar indicates the range Estimated number of adult and child deaths due to AIDS globally, 1990–2007 Million Global HIV Epidemiology Sub-Saharan Africa 68% global HIV incidence and prevalence 76% global AIDS mortality Almost 90% global HIV in children One third of global burden in southern Africa; adult HIV prevalence >15% in 8 countries Clusters possible, generalized epidemics unlikely Caribbean most heavily affected, adult HIV prevalence 1% 3.0 2.5 Rest of the World Concentrated epidemics affecting IDU, MSM, sex workers and their partners Number 2.0 of adult and child 1.5 deaths due to AIDS 1.0 0.5 0 199019911992199319941995199619971998199920002001200220032004200520062007 Year This bar indicates the range Monitoring the HIV/AIDS Pandemic HIV and AIDS case reporting The Cycle of HIV Disease Changing Surveillance Practice – United States 90 450 AIDS Cases & Deaths (Thousands) 70 60 50 40 30 20 10 AIDS Cases 350 300 250 200 150 100 3. Incidence AIDS 2. Prevalence of HIV Infection Countries with concentrated epidemics: - sentinel populations (CSW, STI etc) HIV incidence is critical but difficult to measure 4. Prevalence of AIDS Deaths 1987 1989 1991 1993 1995 Years 1997 1999 2001 50 0 2003 5. Mortality from AIDS 0 1985 Persons Living with AIDS (Thousands) Countries with generalized epidemics: - antenatal sentinel surveillance - population surveys 1. Incidence of HIV Infection 80 Persons living with AIDS 400 2 Heterogeneity of HIV/AIDS Impact of HIV/AIDS in Africa Family, social, and demographic disruption Epidemic of orphans Adverse economic effects Worsening food security Worsening of public services, including health care Threatened stability and security Secondary epidemic of tuberculosis Tuberculosis Trends in East and Southern Africa 800 700 Swaziland Lesotho Botswana South Africa Zambia Zimbabwe Kenya Malawi UR Tanzania Uganda HIV Incidence, Prevalence and Mortality in Zimbabwe per 100,000 pop 600 500 400 300 200 100 0 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 Year AIDS in Asia at End-2007 • • 4.9 million persons living with HIV; SE Asia most heavily affected Epidemics driven by IDU and commercial sex; increasing awareness of MSM Cambodia, Myanmar, Thailand show declining prevalence; Indonesia, Viet Nam increasing India – approximately 2.5 million HIV-infected; commercial sex in south, IDU in north AIDS in Europe at End-2007 • Eastern Europe most heavily affected, 90% HIV infections in Russia and Ukraine; most in IDU • Central Europe – low level epidemic • Western Europe very heterogeneous, heterosexual transmission predominates; African immigrants affected • High or increasing rates in MSM • • • China – approximately half infections in IDU; earlier outbreak in commercial blood donors • Declining rates in IDU in southern Europe 3 HIV/AIDS in the Americas at End2007 • • • • • • US most heavily affected industrialized country - 1,039,000 1,185,000 HIV-infected 1.6 million HIV-infected in Latin America, one third in Brazil Transmission predominantly sexual in Latin America, MSM in many countries Caribbean – 230,000 HIV-infected, adult HIV prevalence 1% Three quarters of infections in Haiti and Domican Republic Predominantly heterosexual transmission, IDU in Puerto Rico and Bermuda 4 Basic Reproductive Rate (Number) • Number of secondary cases generated from one primary case • For HIV, depends on: - Rate of partner change - Transmissibility - Duration of infectiousness Risk Estimates of HIV Infection in Patients Infected with HSV-2 – Meta Analysis (Wald and Link, 2002) Impact of MC on HIV incidence: Evidence from observational studies and RCTs Effect size Study Overall High-risk groups General Population South Africa Kenya Uganda (95% CI) 0.42 ( 0.34, 0.52) 0.29 ( 0.20, 0.42) 0.56 ( 0.44, 0.71) 0.40 ( 0.24, 0.67) 0.41 ( 0.24, 0.70) 0.49 ( 0.28, 0.86) (Longitudinal and nested case control studies) .15 .2 .3 .4 .5 1 1.5 Effect size Universal Access 2005 G8 Summit at Gleneagles, Final Communiqué: “…working with WHO, UNAIDS and other international bodies to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010.” The Health Sector's Contribution to Achieving Universal Access Expanding testing and counseling S T R A T E G I C I N F O R M A T I O N Maximising prevention Accelerating treatment scale up Strengthening health systems 5 HIV Testing in France and UK United Kingdom, 2005 • 43% of HIV-infected MSM left STI clinic undiagnosed 32% of 63,500 PLHA in UK were undiagnosed • • 34% of new HIV diagnoses at CD4 <200 per mcl • • • Recent Guidelines on HIV Testing in Clinical Settings France, 2004 Second highest HIV testing rate in W. Europe 40,000 (circa one third) of HIV-infected persons unaware 40% of new HIV diagnoses at AIDS or CD4 <200 per mcl HIV in MSM, 2008……. HIV case reports in MSM, UK 2500 HIV AIDS Deaths Prevention of mother-to-child transmission The four-pronged strategy • Primary prevention of HIV • Prevention of unwanted pregnancies • Prevention of transmission from HIVinfected mother to infant • Appropriate treatment and care 2000 Number of diagnoses 1500 1000 500 0 19 83 19 81 19 85 19 87 19 97 19 89 19 91 19 95 19 99 20 01 19 93 20 03 20 05 Year of diagnosis Towards HIV-Free Survival Rate of Gastroenteritis Hospitalizations in Early vs Delayed Weaning: GE rate per 100 infants in age group observed 8 7 6 5 4 3 2 1 0 0 1 2 3 4 5 6 7 8 9 10 11 12 GE rate VT GE rate KiBS Unmet treatment need in low- and middle-income countries according to region, December 2006 5 000 000 4 500 000 4 000 000 3 500 000 Number of people 68% of the total unmet need Unmet need ARV therapy Receiving ARV treatment in Dec 2006 3 000 000 2 500 000 2 000 000 1 500 000 1 000 000 500 000 0 Sub-Saharan Africa Latin America and the Caribbean East, South and South-East Asia • Prolonged breast feeding is associated with increased HIV transmission; early weaning with increased infant mortality. HIVfree survival seems unchanged. Europe and Central Asia North Africa and the Middle East Louis Gallait (1810 -1887) The Unhappy Mother PVSK Museum, Antwerp 6 Children's access to HIV treatment, June 2006 • Africa Median: 8% • L. America Median: 8% • Asia Median: 5 % WHO guidance on use of ARV Evolving Challenges in Global Guidance and Practice on HIV/AIDS-2008 • Optimal regimens for PMTCT, including for breast-feeding women • When to start pediatric ART • Guidance on HIV testing in children • When to start ART in adults • Moving away from stavudine • Optimal approaches to monitoring ART • Pharmacovigilance • Access to second and third line ART regimens • Retention and adherence Is too much money spent on AIDS? OP-ED CONTRIBUTOR Putting a Plague in Perspective By DANIEL HALPERIN Published: January 1, 2008 Last year, for instance, as the United States spent almost $3 billion on AIDS programs in Africa, it invested only about $30 million in traditional safe-water projects. This nearly 100-to-1 imbalance is disastrously inequitable….. The Global Fund's director, Michel Kazatchkine, has acknowledged, "We are not a global fund that funds local health." (New York Times, Herald Tribune) Investing in Strategic Information • • • • • • • Progress towards Universal Access at December 2006 WHO/UNAIDS/UNICEF report, April 2007 Antiretroviral treatment Preventing mother-to-child transmission HIV testing and counselling Interventions for injecting drug users STI control HIV surveillance Target-setting • "What gets measured gets done" (Margaret Chan) • "Surveillance is the conscience of any epidemic" (James W. Curran) 7

Related docs
HIV and AIDS
Views: 9  |  Downloads: 1
HIV and AIDS in Bangladesh
Views: 141  |  Downloads: 8
Women and HIV-AIDS - Confronting the Crisis
Views: 379  |  Downloads: 29
HIV - AiDS
Views: 275  |  Downloads: 12
AIDS epidemic update 2007
Views: 282  |  Downloads: 12
Counselling-people-affected-by-HIV-and-AIDS
Views: 5  |  Downloads: 1
HIV and AIDS
Views: 267  |  Downloads: 36
premium docs
Other docs by Piece Piece
Check for the Purchase of Alaska info
Views: 189  |  Downloads: 0
Promissory note
Views: 464  |  Downloads: 16
Transcript of President Abraham Lincoln
Views: 147  |  Downloads: 3
Boulder Canyon Project Act info
Views: 197  |  Downloads: 0
Transcript of United Nations Charter
Views: 137  |  Downloads: 0
Application for requisition
Views: 207  |  Downloads: 0
90 day Notice To Move Out
Views: 1643  |  Downloads: 27
Foia Log of Wood River Technologies
Views: 250  |  Downloads: 1
Application To Rent Or Lease
Views: 1239  |  Downloads: 60
Transcript of Plessy v Ferguson
Views: 255  |  Downloads: 1