title: Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa.
abstract: Our aim was to describe the association between increasing access to antiretroviral therapy and all-cause mortality in South Africa from 2005 to 2009. We undertook a longitudinal, population-level study, using antiretroviral monitoring data reported by PEPFAR implementing partners and province-level and national all-cause mortality records from Statistics South Africa (provider of official South African government statistics) to analyse the association between antiretroviral therapy and mortality. Using mixed effects models with a random intercept for province, we estimated the contemporaneous and lagging association between antiretroviral therapy and all-cause mortality in South Africa. We also conducted subgroup analyses and estimated the number of deaths averted. For each 100 HIV-infected individuals on antiretroviral therapy reported by PEPFAR implementing partners in South African treatment programmes, there was an associated 2.9 fewer deaths that year (95% CI: 1.5, 4.2) and 6.3 fewer deaths the following year (95% CI: 4.6, 8.0). The associated decrease in mortality the year after treatment reporting was seen in both adults and children, and men and women. Treatment provided from 2005 to 2008 was associated with 28,305 deaths averted from 2006 to 2009. The scale-up of antiretroviral therapy in South Africa was associated with a significant reduction in national all-cause mortality.
authors.affiliation: American Schools of Public Health based at U.S. Centers for Disease Control and Prevention, Pretoria, South Africa elysia.larson@gmail.com.
authors.forename: Elysia
authors.initials: E
authors.lastname: Larson
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
authors.affiliation: Statistics South Africa, South Africa.
authors.forename: Maletela
authors.initials: M
authors.lastname: Tuoane-Nkhasi
authors.affiliation: National Department of Health, South Africa.
authors.forename: Thobile
authors.initials: T
authors.lastname: Mbengashe
authors.affiliation: U.S. Centers for Disease Control and Prevention, Pretoria, South Africa.
authors.forename: Thurma
authors.initials: T
authors.lastname: Goldman
authors.affiliation: U.S. Agency for International Development, Washington, DC, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Wilson
authors.affiliation: U.S. Centers for Disease Control and Prevention, Pretoria, South Africa.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D000328:Adult; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000600:supply & distribution* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Africa; HIV; PEPFAR; antiretroviral therapy; mortality decline; treatment