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. 2014 Oct 29:7:25370.
doi: 10.3402/gha.v7.25370. eCollection 2014.

HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

P Kim Streatfield  1 , Wasif A Khan  2 , Abbas Bhuiya  3 , Syed M A Hanifi  3 , Nurul Alam  4 , Ourohiré Millogo  5 , Ali Sié  5 , Pascal Zabré  5 , Clementine Rossier  6 , Abdramane B Soura  7 , Bassirou Bonfoh  8 , Siaka Kone  8 , Eliezer K Ngoran  9 , Juerg Utzinger  10 , Semaw F Abera  11 , Yohannes A Melaku  11 , Berhe Weldearegawi  11 , Pierre Gomez  12 , Momodou Jasseh  12 , Patrick Ansah  13 , Daniel Azongo  13 , Felix Kondayire  13 , Abraham Oduro  13 , Alberta Amu  14 , Margaret Gyapong  14 , Odette Kwarteng  14 , Shashi Kant  15 , Chandrakant S Pandav  15 , Sanjay K Rai  15 , Sanjay Juvekar  16 , Veena Muralidharan  16 , Abdul Wahab  17 , Siswanto Wilopo  17 , Evasius Bauni  18 , George Mochamah  18 , Carolyne Ndila  18 , Thomas N Williams  19 , Sammy Khagayi  20 , Kayla F Laserson  20 , Amek Nyaguara  20 , Anna M Van Eijk  20 , Alex Ezeh  21 , Catherine Kyobutungi  21 , Marylene Wamukoya  21 , Menard Chihana  22 , Amelia Crampin  23 , Alison Price  23 , Valérie Delaunay  24 , Aldiouma Diallo  24 , Laetitia Douillot  24 , Cheikh Sokhna  24 , F Xavier Gómez-Olivé  25 , Paul Mee  25 , Stephen M Tollman  26 , Kobus Herbst  27 , Joël Mossong  28 , Nguyen T K Chuc  29 , Samuelina S Arthur  30 , Osman A Sankoh  31 , Peter Byass  32
Affiliations

HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

P Kim Streatfield et al. Glob Health Action. .

Abstract

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.

Design: 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.

Keywords: Africa; Asia; HIV/AIDS; INDEPTH Network; InterVA; Mortality; Verbal Autopsy; tuberculosis.

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Figures

Fig. 1
Fig. 1
Map showing participating sites, with age–sex–time adjusted cause-specific mortality fractions and adjusted mortality rates for HIV/AIDS.
Fig. 2
Fig. 2
Epidemic curves for HIV/AIDS mortality rates for the five sites where overall HIV/AIDS mortality exceeded 1 per 1,000 person-years.
Fig. 3
Fig. 3
Relationship between HIV/AIDS and pulmonary TB age–sex–time standardised mortality rates for 22 INDEPTH Network sites in Africa and Asia.
Fig. 4
Fig. 4
Mortality rates for HIV/AIDS, pulmonary TB, and pneumonia, by site and age group at 15 INDEPTH Network sites for which the overall rate of HIV/AIDS mortality exceeded 0.1/1,000 person-years.
See this image and copyright information in PMC

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