title: The impact of antiretroviral therapy on adult mortality in rural Tanzania.
abstract: OBJECTIVE
  To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north-west Tanzania.
  
  
  METHODS
  Serological and demographic surveillance rounds have been undertaken in a population of approximately 30,000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV-negative and HIV-positive adults in the 5-year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non-linear relationship between these two variables.
  
  
  RESULTS
  Male and female mortality patterns varied over the pre- and post-ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51-0.99 and HRR = 0.68; 95%CI: 0.46-0.99, respectively). For men, the mortality among the HIV negatives increased (HRR = 1.47; 95%CI: 1.06-2.03) while the decline in mortality among the HIV positives (HRR = 0.77; 95%CI 0.52-1.13) was not statistically significant. The largest decrease in HIV-positive mortality over the two periods was among the 30- to 44-year-old age group for women and among the 45- to 59-year-old age group for men.
  
  
  CONCLUSIONS
  There has been a modest effect on mortality in the study population following the introduction of free ART 5 years ago. Improving access to treatment and placing greater focus on retaining individuals on treatment are essential if the full potential of treatment for reducing HIV-related mortality is to be realised.
authors.affiliation: London School of Hygiene and Tropical Medicine, UK. Milly.marston@lshtm.ac.uk
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.forename: Denna
authors.initials: D
authors.lastname: Michael
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.forename: Raphael
authors.initials: R
authors.lastname: Isingo
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Clark
authors.forename: Aswile
authors.initials: A
authors.lastname: Jonas
authors.forename: Julius
authors.initials: J
authors.lastname: Mngara
authors.forename: Samweli
authors.initials: S
authors.lastname: Kalongoji
authors.forename: Joyce
authors.initials: J
authors.lastname: Mbaga
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012424:Rural Population / Q000706:statistics & numerical data; D012698:Serologic Tests; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents