Sustained 10-year gain in adult life expectancy following antiretroviral therapy roll-out in rural Malawi: July 2005 to June 2014. (14th October 2016)

• Record Type: Journal Article
• Authors: Price, Alison J; Glynn, Judith; Chihana, Menard; Kayuni, Ndoliwe; Floyd, Sian; Slaymaker, Emma; Reniers, Georges; Zaba, Basia; McLean, Estelle; Kalobekamo, Fredrick; Koole, Olivier; Nyirenda, Moffat; Crampin, Amelia C
• Is Part Of: International journal of epidemiology. Volume 46:Number 2(2017)
• Page Start: 479
• Page End: 491
• Publication Date: 2016-10-14
• Subjects: HIV, ART, mortality, life-expectancy, Malawi, sub-Saharan Africa; Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyw208
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: Improved life expectancy in high HIV prevalence populations has been observed since antiretroviral therapy (ART) scale-up. However, it is unclear if the benefits are sustained, and the mortality among HIV-positive individuals not (yet) on ART is not well described. We assessed temporal change in mortality over 9 years in rural Malawi. Methods: Within a demographic surveillance site in northern rural Malawi, we combined demographic, HIV and ART uptake data. We calculated life expectancy using Kaplan-Meier estimates, and compared mortality rates and rate ratios using Poisson regression, by period of ART availability (July 2005–June 2008, July 2008–June 2011 and July 2011–June 2014). Results: Among 32 664 individuals there were 1424 deaths; 1930 individuals were known HIV-positive, of whom 1382 started ART. Overall, life expectancy at age 15 years increased by 10 years within 5 years of ART introduction, and plateaued. Age-standardized adult mortality rates declined from 11.3/1000 to 7.5/1000 person-years between the first and last time period. In July 2011-June 2014 compared with July 2005–June 2008, mortality declined in HIV-positive individuals on ART (rate ratio adjusted (aRR) for age, sex, location and education, 0.3; 95% confidence interval (CI) 0.2–0.5) and in those not (yet) on ART (aRR 0.3; 95%CI 0.1–0.5) but not in HIV-negative individuals (aRR 1.1; 95%CI 0.7–1.9). Conclusions: Total population adult life expectancy increased toward that of HIV-negative individuals by 2011 and remained raised. The reduction in all-cause and HIV-related mortality in HIV-positive individuals not (yet) on ART suggests ART uptake is occurring at an earlier disease stage, particularly in women.