Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa

Larson, Elysia; Bendavid, Eran; Tuoane-Nkhasi, Maletela; Mbengashe, Thobile; Goldman, Thurma; Wilson, Melinda; Klausner, Jeffrey D.

doi:10.1177/0956462413515639

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…We document gains of 3.1 years in adult life expectancy and 8 years of median length of life in the four years following the introduction of public-sector ART in rural Malawi. Our estimated mortality rates and the change in mortality rate post-ART are similar to published results from the Karonga HDSS in Malawi ( Floyd et al 2010 ; Larson et al 2014 ; Price et al 2016 ) and those of other HDSS sites in Southern and Eastern Africa ( Floyd et al 2012 ).…”

Section: Discussionsupporting

confidence: 86%

“…Starting in the early 2000s, access to ART through public-sector programs was greatly improved in SSA. Recent studies have started to document the success of these programs in terms of population-level declines in mortality (both HIV-related and all-cause) in South Africa ( Bor et al 2013 ; Larson et al 2014 ), Malawi ( Floyd et al 2010 ; Jahn et al 2008 ; Price et al 2016 ), and other countries in SSA ( Floyd et al 2012 ; Stoneburner et al 2014 ).…”

Section: Introductionmentioning

confidence: 99%

“…An important aspect of the recent evidence on post-ART mortality change is that it is based largely on data from populations enrolled in health and demographic surveillance sites (HDSS), with the notable exception of a small group of studies based on aggregate-level data ( Larson et al 2014 ; Mwagomba et al 2010 ; Stoneburner et al 2014 ; Stover et al 2008 ; Pillay-van Wyk et al 2013 ). Though HDSSs are a valuable resource, the external validity of HDSS-based findings is potentially limited.…”

Section: Introductionmentioning

confidence: 99%

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The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi

Payne

Kohler

2017

DemRes

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BACKGROUNDRecent evidence from health and demographic surveillance sites (HDSS) has shown that increasing access to antiretroviral therapy (ART) is reducing mortality rates in sub-Saharan Africa (SSA). However, due to limited vital statistics registration in many of the countries most affected by the HIV/AIDS epidemic, there is limited evidence of the magnitude of ART’s effect outside of specific HDSS sites. This paper leverages longitudinal household/family roster data from the Malawi Longitudinal Survey of Families and Health (MLSFH) to estimate the effect of ART availability in public clinics on population-level mortality based on a geographically dispersed sample of individuals in rural Malawi.OBJECTIVEWe seek to provide evidence on the population-level magnitude of the ART-associated mortality decline in rural Malawi and confirm that this population is experiencing similar declines in mortality as those seen in HDSS sites.METHODSWe analyze longitudinal household/family-roster data from four waves of the MLSFH to estimate mortality change after the introduction of ART to study areas. We analyze life expectancy using the Kaplan–Meier estimator and examine how the mortality hazard changed over time by individual characteristics with Cox regression.RESULTSIn the four years following rollout of ART, life expectancy at age 15 increased by 3.1 years (95% CI 1.1, 5.1), and median length of life rose by over ten years.CONTRIBUTIONOur observations show that the increased availability of ART resulted in a substantial and sustained reversal of mortality trends in SSA and assuage concerns that the post-ART reversals in mortality are not occurring at the same magnitude outside of specific HDSSs.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi

Payne

Kohler

2017

DemRes

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“…Before 2003, most Kenyans had no access to HIV services, but by 2008, 1 in 5 HIV-positive adults were receiving HIV care, with half of those eligible receiving antiretroviral therapy [24]. A South African study found that for every 100 HIV-infected persons on antiretroviral therapy, 6.3 fewer deaths occurred the following year, including among children [25]. Studies in the KEMRI/CDC HDSS showed a halving of all-cause and HIV-specific mortality among young adult females from 2003 to 2009 [26].…”

Section: Discussionmentioning

confidence: 99%

Age-Specific Malaria Mortality Rates in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya, 2003–2010

et al. 2014

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Recent global malaria burden modeling efforts have produced significantly different estimates, particularly in adult malaria mortality. To measure malaria control progress, accurate malaria burden estimates across age groups are necessary. We determined age-specific malaria mortality rates in western Kenya to compare with recent global estimates. We collected data from 148,000 persons in a health and demographic surveillance system from 2003–2010. Standardized verbal autopsies were conducted for all deaths; probable cause of death was assigned using the InterVA-4 model. Annual malaria mortality rates per 1,000 person-years were generated by age group. Trends were analyzed using Poisson regression. From 2003–2010, in children <5 years the malaria mortality rate decreased from 13.2 to 3.7 per 1,000 person-years; the declines were greatest in the first three years of life. In children 5–14 years, the malaria mortality rate remained stable at 0.5 per 1,000 person-years. In persons ≥15 years, the malaria mortality rate decreased from 1.5 to 0.4 per 1,000 person-years. The malaria mortality rates in young children and persons aged ≥15 years decreased dramatically from 2003–2010 in western Kenya, but rates in older children have not declined. Sharp declines in some age groups likely reflect the national scale up of malaria control interventions and rapid expansion of HIV prevention services. These data highlight the importance of age-specific malaria mortality ascertainment and support current strategies to include all age groups in malaria control interventions.

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“…The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality [1]. AIDS-related deaths have fallen by 48% since the peak in 2005 [2].…”

Section: Introductionmentioning

confidence: 99%

A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?

et al. 2019

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BackgroundThe roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa.MethodsWe used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death.ResultsOf the 559, (386, 69%) were female, median age 36 years (IQR: 21–44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/μL (IQR: 21–163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi’s Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%).ConclusionDespite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases.Electronic supplementary materialThe online version of this article (10.1186/s12879-019-3724-x) contains supplementary material, which is available to authorized users.

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Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa

Cited by 8 publications

References 17 publications

The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi

The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi

Age-Specific Malaria Mortality Rates in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya, 2003–2010

A decade of antiretroviral therapy in Uganda: what are the emerging causes of death?

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