Fast Track progress in Ethiopia comparing with neighboring countries in East Africa
Progress in reducing new HIV infection
To achieve SDG target 3.3, countries are expected to reduce new HIV infection by 75% between 2010 and 2020. The data has shown slow progress to achieve the 2020 milestone in Ethiopia and neighboring countries but Uganda has already achieved it. Ethiopia has reduced the HIV incidence by 13.3% while Eritrea has recorded a 13.6% increase between 2010 and 2017 (Fig 1).
Fig 1. Age-standardized HIV incidence and HIV/AIDS related mortality rates per 100, 000 populations from 2010 to 2017 in Ethiopia and neighboring East African countries
Progress in reducing HIV/AIDS related deaths
All the countries in East Africa, neighboring Ethiopia recorded a significant decline in HIV/AIDS related mortality between 2010 and 2017. Ethiopia, Tanzania, Rwanda, and Uganda have already achieved 75% mortality reduction expected to happen by 2020, while Eritrea and Kenya achieved 56% and 53% respectively (Fig 1)
Tracking progress using incidence:prevalence ratio
According to the UNAIDS, an incidence:prevalence ratio less than 0.03 indicates a country’s positive progress towards an epidemic transition as described in the methods section. The ratio for Ethiopia had been less than 0.03 since 2010, while Rwanda and Uganda achieved this benchmark in 2017. The ratio for Eritrea remained greater than 0.03 since 2010 showing a year by year increase (Fig 2).
Fig 2. Age-standardized HIV incidence:prevalence ratio in Ethiopia and neighboring East African countries from 2010 to 2017
Tracking resource needs using incidence:mortality ratio
As shown in fig 3, most of the East African countries neighboring Ethiopia have more people newly infected with HIV than those dying from HIV/AIDS, which gave a ratio of greater than 1. By contrast, Ethiopia had more people dying from HIV/AIDS than those who acquired new HIV infections. In 2017, the age-standardized incidence: mortality ratio for Ethiopia was 0.79. Kenya, Rwanda, Tanzania, and Uganda had a ratio of greater than 1 due to the high rate of new infections and these countries require more resources to address the problems.
Fig 3. Age-standardized HIV/AIDS incidence:mortality ratio in Ethiopia and neighboring East African countries from 2010 to 2017
Burden of HIV/AIDS in Ethiopia across ages
Incidence across ages
The age-standardized annual HIV incidence rate has declined by 13% in 2017 compared to 2010 (Table 1). This corresponds to a 13% decline in the number of people acquiring new infection from 16,676 (12,475, 21,796) in 2010 to 14, 484 (8,277, 22,958) in 2017. The HIV incidence rate was highest among under 5 children from 2010 to 2015, while in 2017 the HIV incidence rate was highest among the 15-49 age group. Compared to the 2010 baseline, in 2017 the under 5 age group had recorded a 77% decline in HIV incidence rate, while the 15-49 age group recorded a 12% increase from compared to the 2010 baseline. The HIV incidence rate among 5 -14 age groups remained zero over the years (Table 1).
Of the total of 14,483 (8, 277.02 -22, 958,39) new HIV infections that occurred in 2017, 13.7% or 1, 991 (1,344 -2,793) were among under 5 age group and 80.8% or 11,699 (6,108 -19,306) among 15 - 49 age group.
HIV/AIDS prevalence across ages
The age-standardized HIV/AIDS prevalence rate has reduced by 23% in 2017 compared to the 2010 baseline (Table 1). This corresponds to a 15% significant decline in the number of people living with HIV from 770, 657 (682,580, 887,466) in 2010 to 657, 394 (583,397 -738,517) in 2017. Between 2010 and 2017, the highest significant HIV prevalence rate decline (64%) was observed among the under 5 age group, followed by the 5-14 age groups (54%). On the contrary, the HIV prevalence rate among the 50-69 age groups had shown an increase of 37% between 2010 to 2017. The HIV prevalence rate was highest among the 15-49 age group until 2010, since then the 50-69 age group has taken over the lead (Table 1).
Of the total 657, 394 people living with HIV/AIDS in 2017, 2.3% or15,328 (11,405 -19,916) were under 5 years old children, 9.7% or 640,10 (52,934 -76,638) were 5-14 years of age, 67.8% or 445,588 (397, 219 -504, 089) were 15- 49 years of age and 18.4% or 121,018 (94,698 -156, 603) were 50 -69 years of age.
Table 1. All age, age-standardized and age-specific HIV/AIDS incidence, deaths, prevalence, and DALYs rates per 100,000 populations in Ethiopia from 2001 to 2017,
HIV/AIDS related mortality across ages
As shown in Table 1, the age-standardized mortality rate has declined by 74% from 74 deaths for 100, 000 populations in 2010 to 19 for a 100,000 population in 2017. This corresponds to a 65% significant decreased in the number of people dying from HIV/AIDS from 49, 484 (43,908, 55,643) in 2010 to 17,181 (14,600, 20,099) in 2017. Between 2010 and 2017, the HIV/AIDS related mortality has shown a 70% decline among the under 5 age group, 66.7% among the 15-49 years, and 63%the among the 50 -69 age group and 48% decline among the 5-14 age group (Table 1).
In 2017, an estimated 17,181 people died due to HIV/AIDS, of these 13% or 2,254 (1,652-2,988) were among <5 age group; 13 % or 2,274 (1,882-2,687) were among 5-14 age group; 63% or 10,831 (9,062-12,884) were among 15-49 age group and 10% or 1,734 (1,198-2,406) were among 50-69 age group. Over the years’ mortality remained highest among the 50-69 age group. The mortality gap across the age groups has narrowed down in recent years (Table 1)
Disability Adjusted Life Years (DALYs) across ages
As shown in Table 2, in 2017, the age-standardized rate of DALYs was 1.095.6/100 000 populations, which corresponds to 1,116,408 DALYs for all ages. In 2017, the age group 15-49 had the highest (1,335/ 100,000 populations) age-specific rate of DALYs followed by the under 5 age group (1.190/100,000 populations). DALYs has shown significant decline between 2010 and 2017 in all age groups but remained highest among 15-45 age group followed by under 5 age group. Under 5 age group recorded the highest decline (72%) in the rate of DALYs between 2010 and 2017, while the age group 5 -14 recorded the least (55%) (Table 1).