title: The effect of antiretroviral therapy provision on all-cause, AIDS and non-AIDS mortality at the population level--a comparative analysis of data from four settings in Southern and East Africa.
abstract: OBJECTIVE
  To provide a broad and up-to-date picture of the effect of antiretroviral therapy (ART) provision on population-level mortality in Southern and East Africa.
  
  
  METHODS
  Data on all-cause, AIDS and non-AIDS mortality among 15-59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll-out, to 4-6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV-negative and HIV-positive individuals. For Karonga and the Africa Centre, trends in AIDS and non-AIDS mortality are analysed using verbal autopsy data.
  
  
  RESULTS
  For all-cause mortality, overall rate ratios (RRs) comparing the period 2-6 years following ART roll-out with the pre-ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person-years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person-years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person-years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person-years) in the Africa Centre DSS. The mortality decline was seen only in HIV-positive individuals/AIDS mortality, with no decline in HIV-negative individuals/non-AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower.
  
  
  CONCLUSIONS
  Falls in all-cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. sian.floyd@lshtm.ac.uk
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.forename: Kobus
authors.initials: K
authors.lastname: Herbst
authors.forename: Menard
authors.initials: M
authors.lastname: Chihana
authors.forename: Ivan
authors.initials: I
authors.lastname: Kasamba
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Neil
authors.initials: N
authors.lastname: French
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D017678:Sex Distribution; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents