Background: Clinical trials and observational studies have demonstrated that antiretroviral treatment can reduce the risk of HIV transmission. However, many countries still have low rates of antiretroviral treatment uptake.
Methods: Standardised epidemiological data were compiled from 36 African and 17 non-African low- and middle-income countries with least 40,000 HIV-infected people. Estimates of new HIV infections in 2013 by country were calculated using the AIDS Impact Module (AIM) in Spectrum. Each country entered HIV prevalence rates from pregnant women attending antenatal care or from key risk groups, the numbers receiving antiretroviral treatment, the numbers of pregnant women taking antiretroviral therapy (ART) to prevent vertical transmission, and the national antiretroviral eligibility criteria into the AIM. ART coverage rate was defined as the total number receiving ART divided by the epidemic size in each country. HIV transmission rate was defined as the number of new infections per year divided by the epidemic size in each country. Weighted least squares (WLS) regression was used to investigate the association between HIV transmission rates and antiretroviral treatment coverage across the 53 countries.
Results: An estimated 30.2 million people were infected with HIV in the 53 countries, among whom 11.0 million (36%) were receiving ART. However ART coverage rates ranged widely, from 1% in Madagascar to 70% in Botswana; 11/53 countries had <20% of HIV-infected people taking ART. In 2013, there were an estimated 1.81 million new HIV infections in these countries (mean HIV transmission rate=6%). The regression analysis showed that, for every 10% increase in antiretroviral treatment coverage there was approximately a 1.14% decrease in the HIV transmission rate. According to these analyses, if all 53 low and middle-income countries had had the same percentage of HIV-infected people taking antiretrovirals as Botswana (70%), 1.57 million of the 1.81 million total HIV infections in 2013 (87%) could have been prevented. The analysis was repeated using the 2014 Global Burden of Disease database, with similar results.
Conclusions: In these 53 low and middle-income countries with large HIV epidemics, there is the potential to prevent 1.57/1.81 million new HIV infections per year (87%) by increasing antiretroviral treatment coverage to levels already achieved by Botswana.
HIV Transmission rates versus ART coverage in 2013 by country