By Chauna Gibson
Introduction & Background
Over the past decade, there have been major strides in the fight against HIV/AIDS in sub-Saharan Africa. AIDS related deaths have decreased by 38% since their peak in 2005, and 4.8 million deaths have been avoided by the development and delivery of antiretroviral therapy in sub-Saharan Africa alone. Alongside these efforts in HIV treatment, people are increasingly developing non-communicable diseases (NCDs), now the world’s leading killer (Satyam, 2017).
NCDs include multiple conditions such as mental illness, CVD, neurological disorders, pulmonary diseases, cancer and diabetes. NCDs accounted for 23% of deaths in sub-Saharan Africa in 2005 and 33% in 2015 according to WHO’s World Health Statistics. Deaths due to non-communicable diseases are expected to increase at a much greater rate than are deaths from infectious diseases (Bloom et al., 2011).
NCDs are likely to become more common as the population on ART continues rising. This is due to the fact that NCD risk factors are becoming more common as lifestyles change and rates of urbanization increase. Also, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up scaling of antiretroviral therapy (ART) these numbers are likely to increase further.
Methods & Discussion
Tableau is a software that helps people see and understand their data by creating interactive visualizations. To figure out whether there is a relationship between ART treatment for HIV and higher mortality rates due to NCDs, data from WHO database and the World Bank was inputted into Tableau to create a visual analysis. Data from UNAIDS was used to find the number of deaths due to AIDS in the years 2000, 2010 and 2016 in sub-Saharan Africa.
The WHO database was used to find the number of total deaths in SSA due to NCDs and the World Bank database was used to find the percentage of people covered by ART therapy in SSA for years 2000-1015. This data is compiled in Figure 1 and Figure 2. Data on the number of AIDS related deaths can be found in Figure 3.
Figure 1
The graph above shows that the number of people on ART slowly increased between the years 2000 and 2010. However, there was a rapidly increasing trend in the number of people using ART treatment for HIV from 2010 to 2015 in Sub-Saharan Africa.
Figure 2
From the above graph, the total number of deaths due to NCDs gradually rose from 1,891,000 in the year 2000 to 2,085,000 in 2005. Between 2005 and 2015, the total number of deaths due to NCDs increases while there is a substantial decrease in the number of deaths due to HIV/AIDS.
Figures 1 and 2 are Tableau visualizations showing the number of people on ART, and the percentage of deaths due to NCDs in Sub-Saharan Africa over time. The main points of comparison from Figure 1 are years 2000, 2010, and 2015. In 2000, less than 1% of people living with HIV were receiving ART therapy, 10 years later in 2010, 21% of people had ART coverage. Table 2 visualization shows a similar large jump in the number of deaths due to NCDs. From 2000 to 2010 the percentage of deaths due to NCDs went from 21.87% to 29%. Based on the two graphs, it is evident that the consistent increase in the number of people on ART treatment for HIV/AIDs significantly correlates with increasing percentages of total number of deaths due to NCDs in Sub-Saharan Africa between 2000 and 2015. In addition, due to an increase in the number of people on ART, there has been a major decrease in the number of deaths due to AIDS that correlates with ART coverage. For example, as stated before ART coverage jumped from 1% to 21% between 2000 and 2010. As shown in Figure 3, the number of AIDS related deaths went from 1,200,000 to 1,110,000 during this time. During the following period there was a rapidly increasing trend in the number of people using ART treatment for HIV from 2010 to 2015 in Sub-Saharan Africa, alongside this there was a dramatic decrease in the number of deaths due to AIDS; the number of deaths decreasing from 1,110,000 to 730,000 in 2016.
Figure 3
The increasing number of people on ART implies that there have been significant efforts put in place in the fight against HIV/AIDs in sub-Saharan Africa through funding to increase accessibility, delivery, and coverage of ART among the populations.
As shown in Figure 4, the costs spent in ART treatment in sub-Saharan Africa gradually increased from 2005 to 2008. Following the adjustments made to reduce donor funding in 2010, the costs decreased and gradually increased over the period to the year 2015. Over time, international support from donor countries and other NGOs has come together to launch multiple programs for the fight against AIDS such as the Global Fund to Fight AIDS, tuberculosis, and malaria; and in 2003, the U.S. government established the President’s Emergency Plan for AIDS Relief (PEPFAR). Through these programs and their funding, millions of Africans have been able to be immunized and billions of dollars have gone towards research for new and effective interventions.
When it comes to the costs spent on NCDs, there are no financial reports existing to show efforts put in place in the entire sub-Saharan Africa. However, the costs spent on NCDs involve cross-sectional reports from specific countries. For example, the economic burden of NCDs in Nigeria was $400 million in 2005 and projected to spike to $8 billion in 2015 (Bloom et al., 2011). According to cohort studies of 100,000 people in three or four sub-Saharan countries, the total cost scenarios for NCDS estimated at $2.56 billion for each country per year (Holmes et al., 2010). This implies that estimated costs of $2.56 billion for NCDs in one country in 2010 represents about 18% of total costs ($12.9 billion) spent on ART treatment in the entire SSA in the same year. The high marginal costs is attributed to multiple costs involved in a wide range of illnesses under NCDs compared to only the costs for a single ART treatment for HIV/AIDs. With limited financial initiatives set aside to address NCDs in Sub-Saharan Africa, the mortality rates due to NCDs are expected to increase at a much higher rate compared to the HIV/AIDs-related deaths.
References:
1. AVERT (2016). Funding For HIV and AIDs.
https://www.avert.org/professionals/hiv-around-world/global-response/funding
2. Bloom, D.E., & Cafiero, E.T., et al (2011). The Global Economic Burden of Non
communicable Diseases. Geneva: World Economic Forum.
3. Global status report on noncommunicable diseases 2010. (2011). Geneva: World Health Organization.
4. Satyam P. Non-Communicable Diseases (NCDs): A Global Challenge. Biomed J Sci & Tech Res 1(2)-2017. BJSTR. MS.ID.000185.
5. UNAIDS report on the global AIDS epidemic 2013. Joint United Nations Programme on HIV/AIDS (UNAIDS). http://files.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf