The effect of antiretroviral therapy provision on all‐cause, AIDS and non‐AIDS mortality at the population level – a comparative analysis of data from four settings in Southern and East Africa

Abstract

ObjectiveTo provide a broad and up-to-date picture of the effect of antiretroviral therapy (ART) provision on population-level mortality in Southern and East Africa.MethodsData on all-cause, AIDS and non-AIDS mortality among 15–59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll-out, to 4–6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV-negative and HIV-positive individuals. For Karonga and the Africa Centre, trends in AIDS and non-AIDS mortality are analysed using verbal autopsy data.ResultsFor all-cause mortality, overall rate ratios (RRs) comparing the period 2–6 years following ART roll-out with the pre-ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person-years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person-years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person-years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person-years) in the Africa Centre DSS. The mortality decline was seen only in HIV-positive individuals/AIDS mortality, with no decline in HIV-negative individuals/non-AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower.ConclusionsFalls in all-cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important.

HIV/AIDS-related Expectations and Risky Sexual Behaviour in Malawi

“…By 2011, adult life expectancy had increased to 60.5 years-an 11.3-year gain. Similar reductions due to the expansion of ART have been documented in Malawi and other SSA countries (Floyd et al, 2012). Cohen (2011) reports findings from a clinical trial conducted by the HIV Prevention Trials Network showing that ART reduces the risk of heterosexual HIV transmission by 96%.…”

The History of the HIV/AIDS Epidemic in Africa

“…The nevirapine results (HIVNET 012) set the stage for more innovative and more efficacious preventive strategies which extended the use of nevirapine during lactation for up to 14 weeks [45][46][47] as well as trials to reduce emergency of resistance to nevirapine through addition of such drugs as zidovudine and lamivudine to nevirapine [48]. [50][51][52][53][54][55] with reductions in deaths due to AIDS-defining comorbidities [53]. ART did not only serve a treatment role but also provide additional tools for HIV prevention.…”

The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi

“…In 2003, through support of large international donors and governments, the Malawian government started to make ART available for free, and the ART program has been expanding rapidly since. The scale-up of the program, in Malawi and elsewhere in sub-Saharan Africa, is widely regarded as a public health success and has resulted in measured declines in adult mortality (Jahn et al 2008, Floyd et al 2012, and Payne and Kohler 2017.…”