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

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.

Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

Interview with Elisabeth (Nophie) Dewi

Elisabeth (Nophie) Dewi is an Indonesian who studied at Victoria University in 2006-2010. She studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship. The interview was conducted in English by Dr Jemma Purdey of Deakin University and Dr Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia. The interview was recorded on 30 April 2014. This set comprises: an interview recording, a photograph, and a timed summary.

Interview with Bob Sugeng Hadiwinata

Bob Sugeng Hadiwinata is an Indonesian who studied at Monash University in 1990-1993. He studied on an Australian International Development Bureau (AIDAB) Scholarship and completed a Masters in International Relations. In 1995 he accepted another scholarship to Cambridge University where he completed his PhD. The interview was conducted in English by Dr. Jemma Purdey of Deakin University on 1 May 2014. This set comprises: a recording of the interview, a photograph, and a timed summary.

Interview with Lubna Algadrie

Lubna Algadrie is an Indonesian who studied in Australia at Sydney University in 1977 and again in 1984-1985. This dataset includes an audio recording of a whole-of-life interview conducted with Lubna, which details her personal experiences as a participant in Australian-sponsored tertiary education scholarship programs - the Colombo Plan and the Australian International Development Assistance Bureau (AIDAB) Scholarship. The timed summary is based on the audio recording. The interview was conducted in English by Dr Jemma Purdey of Deakin University. The interview was recorded on 31 May 2014. This set comprises: an interview recording, a timed summary of the interview, and a photograph of Lubna Algadrie - Indonesian alumni 1970 and 1980 cohorts.

Interview with Istiadah Istiadah

Istiadah Istiadah is an Indonesian who studied at Monash University in 1992-1994. She studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a Masters in Language Education. The interview was conducted in English on 23 October 2014 by Dr. Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia. This set comprises: an interview recording and a transcript of the interview.

Interview with James Kaiulo

James Kaiulo is a Papua New Guinean who studied at Macquarie University in 1985-1990. He studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a PhD in Biological Sciences. The interview was conducted in English on 12 February 2015 by Dr. Jonathan Ritchie of Deakin University. This set comprises: an interview recording, and a timed summary.

Interview with R. Inge Komardjaja

R. Inge Komardjaja is an Indonesian who studied at The University of New South Wales in 1991-1995. She studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed PhD in Women's Studies. The interview was conducted in English by Dr. Jemma Purdey of Deakin University and Dr. Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia on 30 April 2014. This set comprises: an interview recording, a timed summary and a photograph.

Interview with T. R. Andi Lolo

T. R. Andi Lolo is an Indonesian who studied at The University of Queensland in 1981-1986 (although he spent 1983 in Indonesia conducting fieldwork). He studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a PhD in Social Sciences. The interview was conducted in English on 25 October 2014 by Dr. Jemma Purdey of Deakin University and Dr. Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia. This set comprises: an interview recording, a photograph, and a timed summary.

Interview with Chusnul Mariyah

Chusnul Mariyah is an Indonesian who studied at The University of Sydney in the 1990s. She studied on an Arts Institute (AI) Scholarship initially, before studying on an Australian International Development Assistance Bureau (AIDAB) Scholarship. While in Australia she completed a Masters and a PhD in Political Science. The interview was conducted in English on 23 April 2014 by Dr. Jemma Purdey and Prof. David Lowe, both of Deakin University. This set comprises: an interview recording, a photograph and a timed summary.

Interview with Dr. Mansur Ma'shum

Dr. Mansur Ma'shum is an Indonesian who studied at Adelaide University in 1983-1988. He studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a PhD in Agricultural Science. The interview was conducted in English on 6 August 2014 by Dr. Jemma Purdey of Deakin University. This set comprises: an interview recording, a timed summary, and a photograph.

Interview with Bernadetha Sarono Mitakda

Bernadetha Sarono Mitakda is an Indonesian who studied at The University of Sydney in 1983-1988. She studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a PhD in Statistics. The interview was conducted in English on 23 October 2014 by Dr. Jemma Purdey of Deakin University. This set comrprises: an interview recording, a timed summary and a photograph.

Interview with Deddy Mulyana

Deddy Mulyana is an Indonesian who studied at Monash University in 1992-1995. Before coming to Australia, he completed his Masters degree in the US on a Fulbright scholarship. He then studied in Melbourne on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed his PhD in Sociology. The interview was conducted in English on 29 April 2014 by Dr. Jemma Purdey of Deakin University and Dr. Ahmad Suaedy of the Abdurrahman Wahid Centre for Inter-faith Dialogue and Peace at Universitas Indonesia. This set comprises: an interview recording in two parts, a timed summary and a photograph.

Interview with Mulyoto Pangestu

Mulyoto Pangestu is an Indonesian who studied in Melbourne on two occasions; in 1993-1996, and in 1998-2005. During his first period of study he started at the University of Melbourne, but transferred to Monash University in 1994. He completed a Graduate Diploma in Agricultural Science in his one year at Melbourne University, before completing his Masters in Reproductive Science at Monash in 1994-1996. The change in field was the reason for his transferral to Monash. After two and a half years back in Indonesia, he returned to Monash University to complete his PhD in Reproductive Science. He was awarded Australian International Development Assistance Bureau (AIDAB) Scholarships to study in Australia. The interview was conducted in English on 18 August 2014 by Dr. Jemma Purdey of Deakin University. This set comprises: an interview recording, a timed summary and a photograph.