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Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study

Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study
Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study

Background: antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world.

Methods: data come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods.

Findings: covering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women.

Interpretation: the burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better engagement with HIV-care services. Gains in adult life-years lived as well as the present life expectancy deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary tuberculosis.

Funding: Wellcome Trust, the Bill & Melinda Gates Foundation, and the National Institutes of Health.

2352-3018
e113-e121
Reniers, Georges
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Blom, Sylvia
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Calvert, Clara
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Martin-Onraet, Alexandra
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Herbst, Abraham J
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Eaton, Jeffrey W
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Bor, Jacob
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Slaymaker, Emma
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Li, Zehang R
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Clark, Samuel J
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Bärnighausen, Till
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Zaba, Basia
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Hosegood, Victoria
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Reniers, Georges
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Blom, Sylvia
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Calvert, Clara
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Martin-Onraet, Alexandra
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Herbst, Abraham J
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Eaton, Jeffrey W
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Bor, Jacob
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Slaymaker, Emma
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Li, Zehang R
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Clark, Samuel J
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Bärnighausen, Till
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Zaba, Basia
e5d3b7e2-e51a-4b2d-a6cd-c90d152623f0
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993

Reniers, Georges, Blom, Sylvia, Calvert, Clara, Martin-Onraet, Alexandra, Herbst, Abraham J, Eaton, Jeffrey W, Bor, Jacob, Slaymaker, Emma, Li, Zehang R, Clark, Samuel J, Bärnighausen, Till, Zaba, Basia and Hosegood, Victoria (2017) Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV, 4 (3), e113-e121. (doi:10.1016/S2352-3018(16)30225-9).

Record type: Article

Abstract

Background: antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world.

Methods: data come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods.

Findings: covering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women.

Interpretation: the burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better engagement with HIV-care services. Gains in adult life-years lived as well as the present life expectancy deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary tuberculosis.

Funding: Wellcome Trust, the Bill & Melinda Gates Foundation, and the National Institutes of Health.

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Accepted/In Press date: 10 October 2016
e-pub ahead of print date: 10 December 2016
Published date: March 2017
Additional Information: Copyright © 2017 Elsevier Ltd. All rights reserved.

Identifiers

Local EPrints ID: 413323
URI: http://eprints.soton.ac.uk/id/eprint/413323
ISSN: 2352-3018
PURE UUID: 2cfbd594-589a-45a1-a057-0a36d13190c9
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

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Date deposited: 21 Aug 2017 16:31
Last modified: 17 Dec 2019 01:40

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