title: Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. kherbst@africacentre.ac.za
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Herbst
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: Angelique
authors.initials: A
authors.lastname: KanyKany
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016730:Program Development; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents