Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019.

BACKGROUND: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. METHODS: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). FINDINGS: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress. INTERPRETATION: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. FUNDING: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding Bill & Melinda Gates Foundation

Effect of change in temperature on the tribological performance of micro surface textured DLC coating

In this study, surface texturing and hydrogenated amorphous carbon (a-C:H) diamond-like carbon (DLC) coating was combined to evaluate the coating performance at various temperatures in oil lubricated reciprocating sliding tests. Micro dimples were created by laser surface texturing on M2 steel using a Pico second laser. DLC coating was deposited by hybrid magnetron sputtering on textured substrates. Textured a-C:H showed stable coefficient of friction at 30, 80, and 125 °C compared to un-textured a-C:H. At 30 °C, graphitization was not observed for both textured and un-textured DLC coating. Graphitization was more pronounced in the case of un-textured a-C:H at 80 and 125 °C. Results show that, at all temperatures tested (30-125 °C), DLC textured samples showed higher wear resistance compared to un-textured DLC coating. The improvement in wear resistance can be explained by the lower graphitization of textured DLC coating. Lower graphitization in the case of textured DLC might be due to the wear particle capturing and lubricant retention ability of textures

Surface Texture Manufacturing Techniques and Tribological Effect of Surface Texturing on Cutting Tool Performance: A Review

The tribological characteristics of sliding surfaces have been remarkably improved by surface texturing. Surface texturing can be beneficial in many ways; for example, it can reduce friction and wear, increase load carrying capacity, and increase fluid film stiffness. The design process for surface texturing is highly correlated to the particular functions of any application for which texturing is required. Texture quality is greatly affected by manufacturing methods, therefore, it is important to have a detailed understanding of the related parameters of any technique. The use of surface texturing to improve the cutting performance of tools is a relatively new application. These textures improve cutting performance by enhancing lubricant availability at the contact point, reducing the tool-chip contact area, and trapping wear debris. Reductions in crater and flank wear, friction force, cutting forces, and cutting temperature are the main benefits obtained by this technique. To date, surface texturing has been successfully used in drilling, milling, and turning operations. This article provides an overview of the techniques that have been used in industry and research platforms to manufacture micro-/nano-textures for tribological applications, and it examines the effects of surface textures on cutting tool performance

Investigation of laser texture density and diameter on the tribological behavior of hydrogenated DLC coating with line contact configuration

The technique of laser texturing has been gaining popularity in recent years because of its use in enhancement of tribological performance. In this paper, the effect of indirect laser texturing is analyzed on hydrogenated DLC coating under line contact configuration. Most previous research studies have been carried out for point contact configuration. The aim of this study is to investigate the effectiveness of indirect laser textured DLC for cam/tappet contact in an engine. For this reason, this study focuses on line contact. The tribological performance of textures is dependent on their geometric parameters. Therefore, textures' diameters and densities were varied. The results indicated that at a diameter of 50-μm and 20% density, tribological performance of a cylinder on a coated plate tribo-pair can be enhanced

Experimental investigation of tribological properties of laser textured tungsten doped diamond like carbon coating under dry sliding conditions at various loads

Laser micro texturing technique has shown its potential in reducing friction and wear at various mechanical interfaces such as automotive and cutting tools etc. Automotive parts are coated with Diamond-like Carbon (DLC) coatings to enhance their performance. Due to stringent condition at the automotive contacts and demand for performance enhancement, increase in performance of DLC coatings is required. In this study laser micro texturing is being combined with tungsten doped DLC coating. In order to analyze the benefits of laser micro texturing on tungsten doped DLC coating. Tribological testing was conducted on a reciprocating test rig at various loading conditions. The results indicated that laser textured tungsten doped DLC coating showed the lower coefficient of friction compared to un-textured tungsten doped DLC coating at a load of 15 N, 25 N and 35 N. Higher graphitization was observed in the case of un-textured coating at 35 N load