Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

Background: Alcohol use disorder (AUD) is common among people living with HIV/AIDS (PLWHA) and associated with a greater risk of poor medication adherence, unsafe sexual behaviors as well as poor quality of life. To our knowledge, there is no previous systematic review and meta-analysis that reported the pooled prevalence estimate of AUD among PLWHA. Therefore, this review aimed to systematically review the available studies on the prevalence of AUD among PLWHA and forward possible recommendations for future clinical practice and research. Methods: PubMed, EMBASE, Psych INFO and SCOPUS databases were searched to identify the relevant studies. We have also scanned the reference lists of the eligible studies to supplement our electronic search. We used the Comprehensive Meta-Analysis software versions 3.0 to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran’s Q- and the I²- test were employed to see the heterogeneity. The presence of publication bias was explored by utilizing Egger’s test and visual inspection of the symmetry in funnel plots. Results: A total of 25 studies with 25,154 participants across developed and developing countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence estimate of AUD among PLWHA was found to be 29.80% (95% CI; 24.10–35.76). The prevalence of AUD was higher in males (26.90%) than female (13.37%) HIV patients. In this study, the pooled prevalence of AUD was considerably higher (31.52%) when measured by Alcohol Use Disorders Identification Test (AUDIT) as compared to Composite International Diagnostic Interview (CIDI) (13.51%). In addition, the pooled prevalence of AUD was higher in the developed countries (42.09%) while lower for developing countries (24.52%). Conclusion: In the current study, the pooled prevalence estimates of AUD among PLWHA was considerably high (29.80%). Screening and appropriate management of AUD among PLWHA are recommended.

Background The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years. Methods We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury. Results Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change. Conclusions While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.

Anxiety and depression are frequently and highly occurring mental disorders in patients with tuberculosis. When depression and anxiety co-morbid with tuberculosis, it leads to poor adherence to anti TB medication, which is important barrier to global control of tuberculosis & increases the risk of morbidity and mortality due to TB. Cross sectional study was conducted to assess prevalence and correlates of depression and anxiety among patients with TB at WolaitaSodo University Hospital and Sodo Health Center, WolaitaSodo, Ethiopia. Institution based cross-sectional study was conducted in 2014.A total of 417 TB patients, who had regular follow up at WolaitaSodo University Hospital and Sodo Health Center, WolaitaSodo, South Ethiopia, were recruited to assess depression and anxiety and its associated correlates. Depression and anxiety were assessed through face to face interviews by trained psychiatry nurses using the hospital anxiety and depression scale (HADS). Correlates for depression and anxiety were assessed using a structured questionnaire, Oslo social support scale and TB stigma Scale. The prevalence of depression and anxiety among patients with TB were 43.4 % (181) and 41.5 % (173) respectively. When we adjusted for the effect of potential confounding variables, patients who had co-morbid HIV infection [AOR = 5.90,(95 % CI: 2.34,15.93)], poor social support [AOR = 18.06, (95 % CI:11.21,25.45)] & perceived TB stigma [AOR = 10.86, (95 % CI:10.26,23.47)] were more likely to have depression as compared to individuals who had no co-morbid HIV infection, good social support and no perceived TB stigma respectively. Patients who had co-morbid HIV infection [AOR = 9.61,(95 % CI:3.56,25.96)], poor social support [AOR = 8.93,(95 % CI: 5.01,15.94)], perceived TB stigma [AOR = 3.11,(95 % CI:1.78,5.42)], being female [AOR = 1.72 (95 % CI: 1.06, 2.95)], current substance use[AOR = 4.88, (95 % CI: 1.79, 13.28)] and being on intensive phase of TB treatment [AOR = 1.91, (95 % CI: 1.08, 3.39)] were more likely to have anxiety as compared to individuals who had no co-morbid HIV infection, good social support, no perceived TB stigma, being male and being on continuous phase of TB treatment respectively. Developing guidelines and training of health workers in TB clinics is useful to screen and treat depression and anxiety among TB patients.

Background: Evidence has shown that the prevalence of depression is much higher among patients with tuberculosis (TB) and this, in turn, may adversely impact compliance with anti-TB medications. Therefore, this systematic review and meta-analysis aimed to quantitatively summarize epidemiologic evidence on the prevalence of depression among patients with TB and formulate a recommendation for future clinical practice as well as research. Methods: We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct this review. We searched PubMed, EMBASE, SCOPUS and Psych INFO to identify relevant studies that investigated the prevalence of depression among TB patients. We also supplemented our electronic search with manual searching to include all pertinent studies in the analysis. We used a Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis and Cochran’s Q- and the I²-statistics were used to assess heterogeneity. The evidence for the presence of publication bias was checked by using Egger’s test and visual inspection of the symmetry in funnel plots. Results: We identified a total of 25 studies that included 4903 participants across seven countries. In our analysis, the pooled estimated prevalence of depression among TB patients was found to be 45.19% (95% CI 38.04–52.55). The prevalence was higher in MDR-TB 52.34% (95% CI 38.09–66.22) than non-MDR-TB 43.47% (95% CI 35.88–51.37) patients. We also found that the pooled prevalence of depression was higher among females 51.54% (95% CI 40.34–62.60) when compared to males 45.25% (95% CI 35.19–55.71). The pooled prevalence of depression was 45.45% as measured by HRDS, and it was 55.62%, 45.52%, and 38.36% as measured by BDI, HADS and PHQ-9, respectively. Conclusion: Our finding suggested that the pooled estimated prevalence of depression among tuberculosis patients was relatively high. Screening and management of depression among TB patients were warranted to alleviate suffering. Moreover, the integration of tuberculosis program with regular psychiatry services may substantially reduce the burden.