The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: a longitudinal population-based study, 1999-2009
Tropical Medicine & International Health, 08/10/2012
Kasamba I et al. – The substantially reduced mortality rate among HIV–positive individuals after antiretroviral therapy (ART) roll–out lends further support to the intensification of efforts to ensure universal access to ART.Methods
- Longitudinal population–based cohort study of approximately 20 000 residents in rural Uganda.
- Mortality in adults aged 15–59 years was determined for the 5–year period (1999–2003) before introduction of ART in January 2004 and for the 5–year period afterwards.
- Poisson regression was used to estimate mortality rate ratios (RRs) for the period before ART, 1 year after ART introduction (from January 2004 to January 2005) and more than 1 year after ART introduction.
- Trends in mortality were analysed by HIV status, age and sex.
- Before ART became available, the mortality rate (deaths per 1000 person–years) was 4.0 (95% CI = 3.3–4.8) among HIV–negative individuals and 116.4 (95% CI = 101.9–133.0) among HIV–positive individuals.
- During the period January 2004–end November 2009, 279 individuals accessed ART.
- In the year after ART was introduced, the mortality rate (deaths per 1000 person–years) among HIV–negative individuals did not change significantly (adjusted RR = 0.95, 95% CI = 0.61–1.47), but among HIV–positive individuals dropped by 25% to 87.4 (adjusted RR = 0.75, 95% CI = 0.53–1.06).
- In the period 2005–2009, the mortality rate (deaths per 1000 person–years) among HIV–positive individuals fell further to 39.9 (adjusted RR = 0.33, 95% CI = 0.26–0.43).
- The effect was greatest among individuals aged 30–44 years, and trends were similar in men and women.