Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa

Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
Bulletin of the World Health Organisation (Impact Factor: 5.09). 10/2009; 87(10):754-62. DOI: 10.2471/BLT.08.058982
Source: PubMed


To investigate trends in adult mortality in a population serviced by a public-sector antiretroviral therapy (ART) programme in rural South Africa using a demographic surveillance system.
Verbal autopsies were conducted for all 7930 deaths observed between January 2000 and December 2006 in a demographic surveillance population of 74,500 in the Umkhanyakude district of northern KwaZulu-Natal province, South Africa. Age-standardized mortality rate ratios (SMRRs) were calculated for adults aged 25 to 49 years, the group most affected by HIV, for the 2 years before 2004 and the 3 subsequent years, during which ART had been available.
Between 2002-2003 (the period before ART) and 2004-2006 (the period after ART), HIV-related age-standardized mortality declined significantly, from 22.52 to 17.58 per 1000 person-years in women 25-49 years of age (P < 0.001; SMRR: 0.780; 95% confidence interval, CI: 0.691-0.881), and from 26.46 to 18.68 per 1000 person-years in men 25-49 years of age (P < 0.001; SMRR: 0.706; 95% CI: 0.615-0.811). On sensitivity analysis the results were robust to the possible effect of misclassification of HIV-related deaths.
Overall population mortality and HIV-related adult mortality declined significantly following ART roll-out in a community with a high prevalence of HIV infection. A clear public health message of the benefits of treatment, as revealed by these findings, should be part of a multi-faceted strategy to encourage people to find out their HIV serostatus and seek care.

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Available from: Frank Tanser, Oct 13, 2015
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    • "Similarly, because of HIV stigma, an HIV-infected child within the family may have adverse consequences on siblings, including access to immunization . However, antiretroviral treatment did not become available in this community until the end of 2004 and did not reach significant population coverage until the end of 2006 [55]. It is thus unlikely that many children in our sample (born 1995–2000) who were infected in the perinatal period survived to school age [56]. "
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    • "Approximately 9.7 mil‐ lion people now receive ART in low-and middle-income countries, representing a 32-fold increase over the last decade [1]. Effective ART reduces viral load (VL) to undetectable levels and dramatically reduces associated mortality and morbidity [2] [3] [4]. As a public health intervention, ART is at the core of a treatment-as-prevention strategy, as reducing community viral load reduces HIV transmissions [4]. "
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