Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)
BACKGROUND:The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare. METHODS:We use data from seven demographic surveill...
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Veröffentlicht in: | AIDS (London) 2014-11, Vol.28 Suppl 4 (Supplement 4), p.S533-S542 |
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creator | Reniers, Georges Slaymaker, Emma Nakiyingi-Miiro, Jessica Nyamukapa, Constance Crampin, Amelia Catharine Herbst, Kobus Urassa, Mark Otieno, Fred Gregson, Simon Sewe, Maquins Michael, Denna Lutalo, Tom Hosegood, Victoria Kasamba, Ivan Price, Alison Nabukalu, Dorean Mclean, Estelle Zaba, Basia |
description | BACKGROUND:The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.
METHODS:We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.
RESULTS:The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.
CONCLUSION:The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to womenʼs greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease. |
doi_str_mv | 10.1097/QAD.0000000000000496 |
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METHODS:We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.
RESULTS:The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.
CONCLUSION:The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to womenʼs greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000000496</identifier><identifier>PMID: 25406756</identifier><language>eng</language><publisher>England: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Adult ; Africa - epidemiology ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral Therapy, Highly Active - methods ; Drug Utilization ; Female ; HIV Infections - drug therapy ; HIV Infections - mortality ; Humans ; Incidence ; Lentivirus ; Male ; Middle Aged ; Retroviridae ; Sex Factors ; Survival Analysis ; The 2013/14 UNAIDS Estimates Methods: Extending The Scope and Granularity of HIV Estimates ; Young Adult</subject><ispartof>AIDS (London), 2014-11, Vol.28 Suppl 4 (Supplement 4), p.S533-S542</ispartof><rights>2014 Lippincott Williams & Wilkins, Inc.</rights><rights>2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3895-45c08228e0e0e1e197b70a770fc62d151c82f058f50405ce5d88f210359005f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25406756$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reniers, Georges</creatorcontrib><creatorcontrib>Slaymaker, Emma</creatorcontrib><creatorcontrib>Nakiyingi-Miiro, Jessica</creatorcontrib><creatorcontrib>Nyamukapa, Constance</creatorcontrib><creatorcontrib>Crampin, Amelia Catharine</creatorcontrib><creatorcontrib>Herbst, Kobus</creatorcontrib><creatorcontrib>Urassa, Mark</creatorcontrib><creatorcontrib>Otieno, Fred</creatorcontrib><creatorcontrib>Gregson, Simon</creatorcontrib><creatorcontrib>Sewe, Maquins</creatorcontrib><creatorcontrib>Michael, Denna</creatorcontrib><creatorcontrib>Lutalo, Tom</creatorcontrib><creatorcontrib>Hosegood, Victoria</creatorcontrib><creatorcontrib>Kasamba, Ivan</creatorcontrib><creatorcontrib>Price, Alison</creatorcontrib><creatorcontrib>Nabukalu, Dorean</creatorcontrib><creatorcontrib>Mclean, Estelle</creatorcontrib><creatorcontrib>Zaba, Basia</creatorcontrib><creatorcontrib>ALPHA Network</creatorcontrib><title>Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>BACKGROUND:The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.
METHODS:We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.
RESULTS:The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.
CONCLUSION:The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to womenʼs greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Africa - epidemiology</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral Therapy, Highly Active - methods</subject><subject>Drug Utilization</subject><subject>Female</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - mortality</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lentivirus</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retroviridae</subject><subject>Sex Factors</subject><subject>Survival Analysis</subject><subject>The 2013/14 UNAIDS Estimates Methods: Extending The Scope and Granularity of HIV Estimates</subject><subject>Young Adult</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkt9u0zAUxiMEYmXwBgj5clxkO3bi2OECKdqAViowxJ9by01OWrPULrbTqu_Cw-JuYwxusCVbOuf7fvaxT5Y9p3BKoRZnn5qLU7g_yrp6kE1oKYqcc0EfZhNgVZ3XhYCj7EkI35OGg5SPsyPGS6gErybZz_fORz2YuCfRo-0CMZbEFRL0mrieaBuNx-jd1ng9HDJeb_avCG5Nh7ZF0nu3vjZ8wLhz_or0zpPG6mEfjF2SubNLE8fOpAi5dJtx0NE4SxY6YEems29nzeziM-l0TMdZ0vTetJqcNPPLafPyafao10PAZ7f7cfb17Zsv59N8_vHd7LyZ520ha56XvAXJmERIkyKtxUKAFgL6tmId5bSVrAcuew4l8BZ5J2XPKBS8Ti_Sl8Vx9vqGuxkXa-xatDEVqzberLXfK6eN-jtjzUot3VaVjNOa0gQ4uQV492PEENXahBaHQVt0Y1BUghRQMiH_L62YAJGWA7W8kbbeheCxv7sRBXXoAZV6QP3bA8n24n41d6bfn_6Hu3NDRB-uhnGHXq1QD3F1zWNQQM6AlpQmZp4ilBe_ACZ9vHE</recordid><startdate>201411</startdate><enddate>201411</enddate><creator>Reniers, Georges</creator><creator>Slaymaker, Emma</creator><creator>Nakiyingi-Miiro, Jessica</creator><creator>Nyamukapa, Constance</creator><creator>Crampin, Amelia Catharine</creator><creator>Herbst, Kobus</creator><creator>Urassa, Mark</creator><creator>Otieno, Fred</creator><creator>Gregson, Simon</creator><creator>Sewe, Maquins</creator><creator>Michael, Denna</creator><creator>Lutalo, Tom</creator><creator>Hosegood, Victoria</creator><creator>Kasamba, Ivan</creator><creator>Price, Alison</creator><creator>Nabukalu, Dorean</creator><creator>Mclean, Estelle</creator><creator>Zaba, Basia</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T2</scope><scope>7T5</scope><scope>7U2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>201411</creationdate><title>Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)</title><author>Reniers, Georges ; Slaymaker, Emma ; Nakiyingi-Miiro, Jessica ; Nyamukapa, Constance ; Crampin, Amelia Catharine ; Herbst, Kobus ; Urassa, Mark ; Otieno, Fred ; Gregson, Simon ; Sewe, Maquins ; Michael, Denna ; Lutalo, Tom ; Hosegood, Victoria ; Kasamba, Ivan ; Price, Alison ; Nabukalu, Dorean ; Mclean, Estelle ; Zaba, Basia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3895-45c08228e0e0e1e197b70a770fc62d151c82f058f50405ce5d88f210359005f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Africa - epidemiology</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiretroviral Therapy, Highly Active - methods</topic><topic>Drug Utilization</topic><topic>Female</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - mortality</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lentivirus</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retroviridae</topic><topic>Sex Factors</topic><topic>Survival Analysis</topic><topic>The 2013/14 UNAIDS Estimates Methods: Extending The Scope and Granularity of HIV Estimates</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reniers, Georges</creatorcontrib><creatorcontrib>Slaymaker, Emma</creatorcontrib><creatorcontrib>Nakiyingi-Miiro, Jessica</creatorcontrib><creatorcontrib>Nyamukapa, Constance</creatorcontrib><creatorcontrib>Crampin, Amelia Catharine</creatorcontrib><creatorcontrib>Herbst, Kobus</creatorcontrib><creatorcontrib>Urassa, Mark</creatorcontrib><creatorcontrib>Otieno, Fred</creatorcontrib><creatorcontrib>Gregson, Simon</creatorcontrib><creatorcontrib>Sewe, Maquins</creatorcontrib><creatorcontrib>Michael, Denna</creatorcontrib><creatorcontrib>Lutalo, Tom</creatorcontrib><creatorcontrib>Hosegood, Victoria</creatorcontrib><creatorcontrib>Kasamba, Ivan</creatorcontrib><creatorcontrib>Price, Alison</creatorcontrib><creatorcontrib>Nabukalu, Dorean</creatorcontrib><creatorcontrib>Mclean, Estelle</creatorcontrib><creatorcontrib>Zaba, Basia</creatorcontrib><creatorcontrib>ALPHA Network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Safety Science and Risk</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reniers, Georges</au><au>Slaymaker, Emma</au><au>Nakiyingi-Miiro, Jessica</au><au>Nyamukapa, Constance</au><au>Crampin, Amelia Catharine</au><au>Herbst, Kobus</au><au>Urassa, Mark</au><au>Otieno, Fred</au><au>Gregson, Simon</au><au>Sewe, Maquins</au><au>Michael, Denna</au><au>Lutalo, Tom</au><au>Hosegood, Victoria</au><au>Kasamba, Ivan</au><au>Price, Alison</au><au>Nabukalu, Dorean</au><au>Mclean, Estelle</au><au>Zaba, Basia</au><aucorp>ALPHA Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2014-11</date><risdate>2014</risdate><volume>28 Suppl 4</volume><issue>Supplement 4</issue><spage>S533</spage><epage>S542</epage><pages>S533-S542</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract>BACKGROUND:The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.
METHODS:We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.
RESULTS:The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.
CONCLUSION:The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to womenʼs greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease.</abstract><cop>England</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>25406756</pmid><doi>10.1097/QAD.0000000000000496</doi><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Africa - epidemiology Anti-Retroviral Agents - therapeutic use Antiretroviral Therapy, Highly Active - methods Drug Utilization Female HIV Infections - drug therapy HIV Infections - mortality Humans Incidence Lentivirus Male Middle Aged Retroviridae Sex Factors Survival Analysis The 2013/14 UNAIDS Estimates Methods: Extending The Scope and Granularity of HIV Estimates Young Adult |
title | Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA) |
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