Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;74(1):93-102.
doi: 10.1080/00324728.2019.1595099. Epub 2019 May 23.

Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda

Dorean Nabukalu  1 , Georges Reniers  2   3 , Kathryn A Risher  2 , Sylvia Blom  2 , Emma Slaymaker  2 , Chodziwadziwa Kabudula  3 , Basia Zaba  2 , Fred Nalugoda  1 , Godfrey Kigozi  1 , Fred Makumbi  1   4 , David Serwadda  1   4 , Steven J Reynolds  5   6 , Milly Marston  2 , Jeffrey W Eaton  7 , Ron Gray  1   6 , Maria Wawer  1   6 , Nelson Sewankambo  1   4 , Tom Lutalo  1   8
Affiliations

Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda

Dorean Nabukalu et al. Popul Stud (Camb). 2020 Mar.

Abstract

There are limited data on the impact of antiretroviral therapy (ART) on population-level adult mortality in sub-Saharan Africa. We analysed data for 2000-14 from the Rakai Community Cohort Study (RCCS) in Uganda, where free ART was scaled up after 2004. Using non-parametric and parametric (Weibull) survival analysis, we estimated trends in average person-years lived between exact ages 15 and 50, per capita life-years lost to HIV, and the mortality hazards of people living with HIV (PLHIV). Between 2000 and 2014, average adult life-years lived before age 50 increased significantly, from 26.4 to 33.5 years for all women and from 28.6 to 33.8 years for all men. As of 2014, life-years lost to HIV had declined significantly, to 1.3 years among women and 0.4 years among men. Following the roll-out of ART, mortality reductions among PLHIV were initially larger in women than men, but this is no longer the case.

Keywords: HIV; Rakai; Uganda; antiretroviral therapy (ART); mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Life-years lived by (a) HIV-negative individuals, (b) HIV-positive individuals, and (c) individuals with unknown HIV status, compared with the population as a whole; and (d) population-wide life-years lived and lost to HIV; all between ages 15 and 50, by sex and calendar year, Uganda 2000–14 Source: Authors’ calculations from RCCS data.
Figure 2
Figure 2
Trends in the total number of deaths among PLHIV (left-hand axis) and all-cause mortality rates for PLHIV (right-hand axis), by treatment status, Uganda 2000–14 Source: As for Figure 1.
Figure A1
Figure A1
Model-predicted hazard of mortality for HIV-positive individuals by sex, calendar year, and ART status, Uganda 2000–14 Note: Dashed vertical line at 2008 represents the spline inflection in the model. Source: As for Figure 1.
See this image and copyright information in PMC

References

    1. Asiki, G., Reniers G., Newton R., Baisley K., Nakiyingi-Miiro J., Slaymaker E., Kasamba I., Seeley J., Todd J., Kaleebu P., and Kamali A.. 2016. Adult life expectancy trends in the era of antiretroviral treatment in rural Uganda (1991–2012), Aids (London, England) 30(3): 487–493. doi: 10.1097/qad.0000000000000930 - DOI - PMC - PubMed
    1. Auld, Andrew F., Ettiegne-Traore Virginie, Tuho Moise Zanga, Mohamed Fayama, Azih Charles, Mbofana Francisco, Mulenga Modest, Wabwire-Mangen Fred, Kwesigabo Gideon, Essombo Joseph, Glaser Elizabeth, Kamiru Harrison, Nuwagaba-Biribonwoha Harriet, Torpey Kwasi, and Van Praag Eric. 2013. Differences between HIV-infected men and women in antiretroviral therapy outcomes — six African countries, 2004–2012, CDC Morbidity and Mortality Weekly Report 62(47): 946–952. - PMC - PubMed
    1. Billioux, V. G., Chang L. W., Reynolds S. J., Nakigozi G., Ssekasanvu J., Grabowski M. K., Ssekubugu R., Nalugoda F., Kigozi G., Kagaayi J., Serwadda D., Gray R. H., and Wawer M. J.. 2017. Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda: An observational study, Journal of the International AIDS Society 20(1): 21590. doi: 10.7448/ias.20.1.21590 - DOI - PMC - PubMed
    1. Bor, Jacob, Herbst Abraham J., Newell Marie-Louise, and Bärnighausen Till. 2013. Increases in adult life expectancy in rural South Africa: Valuing the scale-up of HIV treatment. Science (New York, N.Y.) 339(6122), 10.1126/science.1230413. doi: 10.1126/science.1230413 - DOI - PMC - PubMed
    1. Brinkhof, Martin W. G., Boulle Andrew, Weigel Ralf, Messou Eugène, Mathers Colin, Orrell Catherine, Dabis F., Pascoe M., Egger M., and International epidemiological Databases to Evaluate, Aids . 2009. Mortality of HIV-infected patients starting antiretroviral therapy in Sub-Saharan Africa: Comparison with HIV-unrelated mortality, PLoS Medicine 6(4): e1000066. doi: 10.1371/journal.pmed.1000066 - DOI - PMC - PubMed

Publication types

Substances