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
. 2024 Nov;51(2):1183-1200.
doi: 10.4054/demres.2024.51.38.

Excess mortality associated with HIV: Survey estimates from the PHIA project

Shannon M Farley  1 , Giles Reid  1 , Kay Yuengling  1 , Connor Wright  1 , Vesper H Chisumpa  2 , George Bello  3 , James M Juma  4 , Abigail R Greenleaf  1 , Stephen McCracken  5 , Paul Stupp  5 , Stéphane Helleringer  6 , Jessica Justman  1
Affiliations

Excess mortality associated with HIV: Survey estimates from the PHIA project

Shannon M Farley et al. Demogr Res. 2024 Nov.

Abstract

Background: Incomplete vital statistics systems in resource-limited countries hinder accurate HIV epidemic assessments. Population-based survey data combined with HIV infection biomarkers may partially address this gap, providing excess mortality estimates in households where people living with HIV (PLWH) reside.

Objective: Examine household-level excess HIV mortality in households with PLWH using population-based survey data, including mortality reported by heads of households, and HIV biomarkers.

Methods: We compared mortality between households with and without PLWH using publicly available data from 11 Population-based HIV Impact Assessments conducted between 2015 and 2019 in Cameroon, Côte d'Ivoire, Eswatini, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Eligible, consenting household members provided blood for HIV testing. Household-level regression models estimated deaths per 1,000 person-years (PY) for the three-year period before the survey; death rate ratios were calculated. Quasi-Poisson distribution accounted for household death over-dispersion.

Results: Country-specific deaths rates per 1,000 PY were significantly higher among rural versus urban households for five countries. For example, in Cameroon, the rates were 9.3 (95% confidence interval [CI]: 8.7-9.9) versus 6.5 (95% CI: 5.9-7.1). In six countries, death rates were significantly higher (1.3-1.7-fold) among households with PLWH versus those without. Death rate ratios were significantly higher among rural (1.4-1.8-fold) and urban households (1.6-2.3-fold) with PLWH versus those without in four and three countries, respectively.

Conclusions: General population household survey findings in multiple countries in Africa indicate that households where PLWH resided experienced excess mortality relative to other households.

Contribution: The novel approach we use to describe HIV-related household-level mortality offers an additional method to measure progress toward zero AIDS-related deaths.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:. Death rates and death rate ratios by household HIV status including all ages and sexes combined in 11 countries in the three years before the survey, 2015–2019
Notes: Countries ordered by magnitude of difference. Death rates among households with and without PLWH are listed as ratios with 95% CI.
Figure 2:
Figure 2:. Death rates comparing household HIV status stratified by urban/rural, including all ages and sexes combined in 11 countries in the three years before the survey, 2015–2019
Note: Countries ordered by overall magnitude of difference
Figure 3:
Figure 3:. Death rate ratios comparing households with PLWH and households without PLWH by urban/rural, including all ages and both sexes combined in 11 countries in the three years before the survey, 2015–2019
See this image and copyright information in PMC

Similar articles

  • Progress towards the UNAIDS 90-90-90 targets among persons aged 50 and older living with HIV in 13 African countries.
    Farley SM, Wang C, Bray RM, Low AJ, Delgado S, Hoos D, Kakishozi AN, Harris TG, Nyirenda R, Wadonda N, Li M, Amuri M, Juma J, Kancheya N, Pietersen I, Mutenda N, Natanael S, Aoko A, Ngugi EW, Asiimwe F, Lecher S, Ward J, Chikwanda P, Mugurungi O, Moyo B, Nkurunziza P, Aibo D, Kabala A, Biraro S, Ndagije F, Musuka G, Ndongmo C, Shang J, Dokubo EK, Dimite LE, McCullough-Sanden R, Bissek AC, Getaneh Y, Eshetu F, Nkumbula T, Tenthani L, Kayigamba FR, Kirungi W, Musinguzi J, Balachandra S, Kayirangwa E, Ayite A, West CA, Bodika S, Sleeman K, Patel HK, Brown K, Voetsch AC, El-Sadr WM, Justman JJ. Farley SM, et al. J Int AIDS Soc. 2022 Sep;25 Suppl 4(Suppl 4):e26005. doi: 10.1002/jia2.26005. J Int AIDS Soc. 2022. PMID: 36176030 Free PMC article.
  • Socioeconomic inequalities in the 90-90-90 target, among people living with HIV in 12 sub-Saharan African countries - Implications for achieving the 95-95-95 target - Analysis of population-based surveys.
    Chipanta D, Amo-Agyei S, Giovenco D, Estill J, Keiser O. Chipanta D, et al. EClinicalMedicine. 2022 Sep 17;53:101652. doi: 10.1016/j.eclinm.2022.101652. eCollection 2022 Nov. EClinicalMedicine. 2022. PMID: 36159044 Free PMC article.
  • The epidemiology of HIV population viral load in twelve sub-Saharan African countries.
    Hladik W, Stupp P, McCracken SD, Justman J, Ndongmo C, Shang J, Dokubo EK, Gummerson E, Koui I, Bodika S, Lobognon R, Brou H, Ryan C, Brown K, Nuwagaba-Biribonwoha H, Kingwara L, Young P, Bronson M, Chege D, Malewo O, Mengistu Y, Koen F, Jahn A, Auld A, Jonnalagadda S, Radin E, Hamunime N, Williams DB, Kayirangwa E, Mugisha V, Mdodo R, Delgado S, Kirungi W, Nelson L, West C, Biraro S, Dzekedzeke K, Barradas D, Mugurungi O, Balachandra S, Kilmarx PH, Musuka G, Patel H, Parekh B, Sleeman K, Domaoal RA, Rutherford G, Motsoane T, Bissek AZ, Farahani M, Voetsch AC. Hladik W, et al. PLoS One. 2023 Jun 26;18(6):e0275560. doi: 10.1371/journal.pone.0275560. eCollection 2023. PLoS One. 2023. PMID: 37363921 Free PMC article.
  • The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development.
    Hartinger SM, Palmeiro-Silva YK, Llerena-Cayo C, Blanco-Villafuerte L, Escobar LE, Diaz A, Sarmiento JH, Lescano AG, Melo O, Rojas-Rueda D, Takahashi B, Callaghan M, Chesini F, Dasgupta S, Posse CG, Gouveia N, Martins de Carvalho A, Miranda-Chacón Z, Mohajeri N, Pantoja C, Robinson EJZ, Salas MF, Santiago R, Sauma E, Santos-Vega M, Scamman D, Sergeeva M, Souza de Camargo T, Sorensen C, Umaña JD, Yglesias-González M, Walawender M, Buss D, Romanello M. Hartinger SM, et al. Lancet Reg Health Am. 2024 Apr 23;33:100746. doi: 10.1016/j.lana.2024.100746. eCollection 2024 May. Lancet Reg Health Am. 2024. PMID: 38800647 Free PMC article. Review.
  • Tuberculosis.
    Bloom BR, Atun R, Cohen T, Dye C, Fraser H, Gomez GB, Knight G, Murray M, Nardell E, Rubin E, Salomon J, Vassall A, Volchenkov G, White R, Wilson D, Yadav P. Bloom BR, et al. In: Holmes KK, Bertozzi S, Bloom BR, Jha P, editors. Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 11. In: Holmes KK, Bertozzi S, Bloom BR, Jha P, editors. Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 11. PMID: 30212088 Free Books & Documents. Review.
See all similar articles

References

    1. Brinkhof MWG, Boulle A, Weigel R, Messou E, Mathers C, Orrell O, Dabis F, Pascoe M, and Egger M for IeDEA (2009). Mortality in 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
    1. Feehan DM, Mahy M, Salganik MJ (2017). The network survival method for estimating adult mortality: Evidence from a survey experiment in Rwanda. Demography 54(4): 1503–1528. doi:10.1007/s13524-017-0594-y. - DOI - PMC - PubMed
    1. Ghislain MR, Mushebenge GA, and Magula N (2021). Cause of hospitalization and death in the antiretroviral era in sub-Saharan Africa published 2008–2018: A systematic review. Medicine 100(43): e27342. doi:10.1097/MD.0000000000027342. - DOI - PMC - PubMed
    1. Ghys PD, Williams BG, Over M, Hallett TB, and Godfrey-Faussett P (2018). Epidemiological metrics and benchmarks for a transition in the HIV epidemic. PLoS Medicine 15(10): e1002678. doi:10.1371/journal.pmed.1002678. - DOI - PMC - PubMed
    1. Gona PN, Gona CM, Ballout S, Rao SR, Kimokoti R, Mapoma CC, and Mokdad AH (2020). Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa development community countries, 1990–2017. BMC Public Health 20: 867. doi:10.1186/s12889-020-08988-9. - DOI - PMC - PubMed

LinkOut - more resources