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The impact of antiretroviral therapy on adult mortality in rural Tanzania
Author(s) -
Marston Milly,
Michael Denna,
Wringe Alison,
Isingo Raphael,
Clark Benjamin D.,
Jonas Aswile,
Mngara Julius,
Kalongoji Samweli,
Mbaga Joyce,
Changalucha John,
Todd Jim,
Zaba Basia,
Urassa Mark
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02924.x
Subject(s) - medicine , demography , hazard ratio , mortality rate , population , proportional hazards model , antiretroviral therapy , cohort study , cohort , human immunodeficiency virus (hiv) , tanzania , viral load , immunology , environmental health , confidence interval , geography , environmental planning , sociology
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. Conclusion 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.