Millennium Declaration successful in reducing global burden of HIV, malaria, and TB

1. The worldwide incidence of HIV declined each year since 1997, though in 101 countries the incidence continued to rise. HIV treatments had saved about 19.1 million life-years since 1996. 

2. There was a decrease in incidence rates of tuberculosis (TB) in 15 of 21 regions of the world (comparing rates in 1990-2000 to 2000-2013). 

3. Worldwide malaria incidence peaked in 2003, while reported cases had declined since then, falling around 29%.     

Evidence Rating Level: 2 (Good)            

Study Rundown: During the Millennium Summit of the United Nations in 2000, one of the eight goals to improve health and wellness worldwide was to combat HIV, malaria, and other diseases. The Global Burden of Disease 2013 study assessed the progress so far since the establishment of these goals. The investigators discovered that the worldwide burden of these serious diseases had decreased overall since 2000. As the most comprehensive study to date, this cross-sectional study showed that the HIV epidemic was smaller than estimated by UNAIDS. Compared to WHO estimates, the study saw a higher mortality, lower prevalence and incidence, as well as a smaller fraction of TB related to HIV. TB incidence in HIV – negative individuals had significantly increased from 5.0 million in 1990 to 7.1 million in 2013. The study also noted that malaria burden had peaked in 2004.

The study was funded by Bill & Melinda Gates Foundation.

Click to read the study, published today in The Lancet

Relevant Reading: The millennium development goals report 2013

In-Depth [cross-sectional study]: This large-scaled study assessed changes in worldwide burdens of HIV, malaria, and TB since the Millennium Declaration in 2000. For HIV, the UNAIDS Spectrum model was used to calculate the incidence and mortality. For malaria, data were collected from an updated cause of death database, verbal autopsy data, and other studies that had examined incidence rates. For tuberculosis, the investigators used “cause of death ensemble modeling” to analyze vital registration and verbal autopsy.

The study found that antiretroviral therapy had saved up to 19.1 million life-years since 1996. HIV incidence peaked in 1997 (2.8 million, 95% uncertainty interval [UI] 2.7 to 3.1) and had been declining since. The number of deaths caused by HIV had peaked at 1.7 million (95% UI, 1.6 million to 1.9 million) in 2005 and had declined to 1.3 million (95% UI, 1.3 million to 1.5 million) in 2013. The number of people living with HIV had increased to a reported 29 million as of 2012.

TB incidence rates for HIV – negative individuals had increased from 5.0 million (95% UI, 4.8 million to 5.1 million) in 1990 to 7.1 million (95% UI, 6.9 million to 7.3 million) in 2013. Prevalence rates had increased between 1990 and 2000. From 2000 to 2013, prevalence had been decreasing by 1.3% (95% UI, 1.4 to 1.2) annually.

Global incidence of malaria had peaked in 2003 at 232 million (95% UI, 143 million to 387 million) and had declined to 165 million (95% UI, 95 million to 284 million) in 2013, a 29% reduction. Since 2000, all regions including sub-Saharan Africa had seen decreases in age-standardized incidence and death rates.

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