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. 2012 Aug;17(8):e66-73.
doi: 10.1111/j.1365-3156.2012.02841.x.

The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: a longitudinal population-based study, 1999-2009

Ivan Kasamba  1 , Kathy Baisley, Billy N Mayanja, Dermot Maher, Heiner Grosskurth
Affiliations
Free PMC article

The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: a longitudinal population-based study, 1999-2009

Ivan Kasamba et al. Trop Med Int Health. 2012 Aug.
Free PMC article

Abstract

Objective: To investigate trends in all-cause adult mortality after the roll-out of an antiretroviral therapy (ART) programme in rural Uganda.

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.

Results: 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.

Conclusion: The substantially reduced mortality rate among HIV-positive individuals after ART roll-out lends further support to the intensification of efforts to ensure universal access to ART.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival function for the entire study population in the 5 years before (1999–2003) and after (2004–2009) antiretroviral therapy introduction, by sex.
Figure 2
Figure 2
Mortality rates by sex and age-group, in the 5 years before antiretroviral therapy (ART) introduction and after ART roll-out in 2004, among HIV-positive (top) and HIV-negative (bottom) adults aged 15–59 years.
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