HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.
BACKGROUND
As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data.


OBJECTIVE
To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia.


METHODS
Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population.


RESULTS
The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates.


CONCLUSIONS
Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.
Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana.
P Kim
PK
Streatfield
International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh.
Wasif A
WA
Khan
INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh.
Abbas
A
Bhuiya
INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh.
Syed M A
SM
Hanifi
INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh.
Nurul
N
Alam
INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso.
Ourohiré
O
Millogo
INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso.
Ali
A
Sié
INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso.
Pascal
P
Zabré
INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso; Institut d'Études Démographique et du parcours de vie, Université de Genève, Geneva, Switzerland.
Clementine
C
Rossier
INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso.
Abdramane B
AB
Soura
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Bassirou
B
Bonfoh
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Siaka
S
Kone
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire.
Eliezer K
EK
Ngoran
INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Swiss Tropical and Public Health Institute, Basel, Switzerland.
Juerg
J
Utzinger
INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Semaw F
SF
Abera
INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Yohannes A
YA
Melaku
INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Berhe
B
Weldearegawi
INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia.
Pierre
P
Gomez
INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia.
Momodou
M
Jasseh
INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana.
Patrick
P
Ansah
INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana.
Daniel
D
Azongo
INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana.
Felix
F
Kondayire
INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana.
Abraham
A
Oduro
INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana.
Alberta
A
Amu
INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana.
Margaret
M
Gyapong
INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana.
Odette
O
Kwarteng
INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India.
Shashi
S
Kant
INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India.
Chandrakant S
CS
Pandav
INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India.
Sanjay K
SK
Rai
INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
Sanjay
S
Juvekar
INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
Veena
V
Muralidharan
INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Abdul
A
Wahab
INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Siswanto
S
Wilopo
INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Evasius
E
Bauni
INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
George
G
Mochamah
INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Carolyne
C
Ndila
INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London, United Kingdom.
Thomas N
TN
Williams
INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya.
Sammy
S
Khagayi
INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya.
Kayla F
KF
Laserson
INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya.
Amek
A
Nyaguara
INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya.
Anna M
AM
Van Eijk
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Alex
A
Ezeh
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Catherine
C
Kyobutungi
INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya.
Marylene
M
Wamukoya
INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; African Population and Health Research Center, Nairobi, Kenya.
Menard
M
Chihana
INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom.
Amelia
A
Crampin
INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom.
Alison
A
Price
INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal.
Valérie
V
Delaunay
INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal.
Aldiouma
A
Diallo
INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal.
Laetitia
L
Douillot
INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal.
Cheikh
C
Sokhna
INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
F Xavier
FX
Gómez-Olivé
INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Paul
P
Mee
INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Stephen M
SM
Tollman
INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa.
Kobus
K
Herbst
INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa; National Health Laboratory, Surveillance & Epidemiology of Infectious Diseases, Dudelange, Luxembourg.
Joël
J
Mossong
INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam.
Nguyen T K
NT
Chuc
INDEPTH Network, Accra, Ghana.
Samuelina S
SS
Arthur
INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Hanoi Medical University, Hanoi, Vietnam; osman.sankoh@indepth-network.org.
Osman A
OA
Sankoh
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Sweden.
Peter
P
Byass
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D001208:Asia / Q000453:epidemiology; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000592:standards*; D016208:Databases, Factual; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance
Africa; Asia; HIV/AIDS; INDEPTH Network; InterVA; Mortality; Verbal Autopsy; tuberculosis