Background:
UNAIDS targets aim to reduce new HIV infections below 370,000 by 2025. However, there were 1.3 million new HIV infections worldwide in 2022. Most international funding for treatment and prevention is allocated to countries in Southern/East Africa, with the highest prevalence of HIV. However, countries in West Africa, South America and Asia have significant HIV epidemics despite lower overall HIV prevalence. As shown in clinical trials and incidence surveys, PrEP with TDF/FTC needs to be given to at least 60 people at high risk of HIV transmission to prevent 1 new infection.
Methods:
Epidemiological data were collected from the UNAIDS AIDSinfo 2022 database, which analyses country-level HIV data using the Spectrum model. Key variables were epidemic size, annual HIV infections, HIV-related deaths, ART coverage, PrEP coverage and MTCT. Results were supplemented by PUBMED/EMBASE searches and national reports. We separated countries with epidemics of >40,000 cases into higher-prevalence (≥3.5%) countries (HPCs) and lower-prevalence (<3.5%) countries (LPCs).
Results:
Overall, there were 19.5 million HIV infections in 14 HPCs in Southern/East Africa (53% of epidemic), versus 17.5 million in 54 LPCs (47%). In 2022, despite a smaller total epidemic size, there were more new HIV infections (770,000 vs 468,000), more HIV-related deaths (383,000 vs 225,000), higher rates of MTCT (16% vs 9%), lower ART coverage (67% vs 83%) in LPCs vs HPCs. The rate of HIV epidemic growth (new infections/epidemic size) was 4.4% in LPCs vs 2.6% in HPCs. PrEP was used by 1.3 million in HPCs vs 1.2 million in LPCs. Total use of PrEP is far below the 74 million people required to optimise preventative efficacy.
Conclusions:
Worldwide, 62% of new HIV infections and 63% of HIV-related deaths are now reported in LPCs outside Southern/East Africa. Many of these countries in South America, Asia and West Africa are not as intensively targeted by access programmes, such as PEPFAR and GFATM. To bring global new infections below the UNAIDS target of 370,000 per year by 2025, ART coverage needs to be optimised worldwide, and PrEP coverage expanded to 74 million people, versus 2.5 million currently treated.
