title: Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia.
abstract: OBJECTIVE
  Assessments of population-level effects of antiretroviral therapy (ART) programmes in Africa are rare. We use data from burial sites to estimate trends in adult AIDS mortality and the mitigating effects of ART in Addis Ababa. ART has been available since 2003, and for free since 2005.
  
  
  METHODS
  To substitute for deficient vital registration, we use surveillance of burials at all cemeteries. We present trends in all-cause mortality, and estimate AIDS mortality (ages 20-64 years) from lay reports of causes of death. These lay reports are first used as a diagnostic test for the true cause of death. As reference standard, we use the cause of death established via verbal autopsy interviews conducted in 2004. The positive predictive value and sensitivity are subsequently used as anchors to estimate the number of AIDS deaths for the period 2001-2007. Estimates are compared with Spectrum projections.
  
  
  RESULTS
  Between 2001 and 2005, the number of AIDS deaths declined by 21.9 and 9.3% for men and women, respectively. Between 2005 and 2007, the number of AIDS deaths declined by 38.2 for men and 42.9% for women. Compared with the expected number in the absence of ART, the reduction in AIDS deaths in 2007 is estimated to be between 56.8 and 63.3%, depending on the coverage of the burial surveillance.
  
  
  CONCLUSIONS
  Five years into the ART programme, adult AIDS mortality has been reduced by more than half. Following the free provision of ART in 2005, the decline accelerated and became more sex balanced. Substantial AIDS mortality, however, persists.
authors.affiliation: Population Program, Institute of Behavioral Science, University of Colorado, Boulder, Colorado, USA. georges.reniers@colorado.edu
authors.forename: Georges
authors.initials: G
authors.lastname: Reniers
authors.forename: Tekebash
authors.initials: T
authors.lastname: Araya
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
authors.forename: Nico
authors.initials: N
authors.lastname: Nagelkerke
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.forename: Roel
authors.initials: R
authors.lastname: Coutinho
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D017677:Age Distribution; D019380:Anti-HIV Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D003906:Developing Countries; D004812:Epidemiologic Methods; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents