Trends in all-cause mortality during the scale-up of an antiretroviral therapy programme: a cross-sectional study in Lusaka, Zambia
Identifieur interne : 001974 ( Main/Exploration ); précédent : 001973; suivant : 001975Trends in all-cause mortality during the scale-up of an antiretroviral therapy programme: a cross-sectional study in Lusaka, Zambia
Auteurs : Sujit D. Rathod ; Benjamin H. Chi [Zambie] ; Thankian Kusanthan [Zambie] ; Batista Chilopa [Zambie] ; Jens Levy [Zambie] ; Izukanji Sikazwe [Zambie] ; Peter Mwaba [Zambie] ; Jeffrey Sa Stringer [Zambie]Source :
- Bulletin of the World Health Organization [ 0042-9686 ] ; 2014.
Abstract
To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART).
Between November 2004 and September 2011, we conducted 12 survey rounds as part of a cross-sectional study in Lusaka, with independent sampling in each round. In each survey, we asked the heads of 3600 households to state the number of deaths in their households in the previous 12 months and the number of orphans aged less than 16 years in their households and investigated the heads’ knowledge, attitudes and practices related to human immunodeficiency virus (HIV).
The number of deaths we recorded – per 100 person–years – in each survey ranged from 0.92 (95% confidence interval, CI: 0.78–1.09) in September 2011, to 1.94 (95% CI: 1.60–2.35) in March 2007. We found that mortality decreased only modestly each year (mortality rate ratio: 0.98; 95% CI: 0.95–1.00;
The expansion of ART services in Lusaka was not associated with a reduction in all-cause mortality. Coverage, patient adherence and retention may all have to be increased if ART is to have a robust and lasting impact at population level in Lusaka.
Url:
DOI: 10.2471/BLT.13.134239
PubMed: 25378727
PubMed Central: 4208480
Affiliations:
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Rathod</name><affiliation><nlm:aff id="aff1">Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT,<country>England</country>.</nlm:aff><wicri:noCountry code="nlm country">England</wicri:noCountry></affiliation></author><author><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H" last="Chi">Benjamin H. Chi</name><affiliation wicri:level="1"><nlm:aff id="aff2">Centre for Infectious Disease Research in Zambia, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kusanthan, Thankian" sort="Kusanthan, Thankian" uniqKey="Kusanthan T" first="Thankian" last="Kusanthan">Thankian Kusanthan</name><affiliation wicri:level="1"><nlm:aff id="aff3">University of Zambia, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Chilopa, Batista" sort="Chilopa, Batista" uniqKey="Chilopa B" first="Batista" last="Chilopa">Batista Chilopa</name><affiliation wicri:level="1"><nlm:aff id="aff4">Zambian Central Statistical Office, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Levy, Jens" sort="Levy, Jens" uniqKey="Levy J" first="Jens" last="Levy">Jens Levy</name><affiliation wicri:level="1"><nlm:aff id="aff2">Centre for Infectious Disease Research in Zambia, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sikazwe, Izukanji" sort="Sikazwe, Izukanji" uniqKey="Sikazwe I" first="Izukanji" last="Sikazwe">Izukanji Sikazwe</name><affiliation wicri:level="1"><nlm:aff id="aff2">Centre for Infectious Disease Research in Zambia, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Mwaba, Peter" sort="Mwaba, Peter" uniqKey="Mwaba P" first="Peter" last="Mwaba">Peter Mwaba</name><affiliation wicri:level="1"><nlm:aff id="aff5">Zambian Ministry of Health, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Stringer, Jeffrey Sa" sort="Stringer, Jeffrey Sa" uniqKey="Stringer J" first="Jeffrey Sa" last="Stringer">Jeffrey Sa Stringer</name><affiliation wicri:level="1"><nlm:aff id="aff2">Centre for Infectious Disease Research in Zambia, Lusaka,<country>Zambia</country>.</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Bulletin of the World Health Organization</title><idno type="ISSN">0042-9686</idno><idno type="eISSN">1564-0604</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Objective</title><p>To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART).</p></sec><sec><title>Methods</title><p>Between November 2004 and September 2011, we conducted 12 survey rounds as part of a cross-sectional study in Lusaka, with independent sampling in each round. In each survey, we asked the heads of 3600 households to state the number of deaths in their households in the previous 12 months and the number of orphans aged less than 16 years in their households and investigated the heads’ knowledge, attitudes and practices related to human immunodeficiency virus (HIV).</p></sec><sec><title>Findings</title><p>The number of deaths we recorded – per 100 person–years – in each survey ranged from 0.92 (95% confidence interval, CI: 0.78–1.09) in September 2011, to 1.94 (95% CI: 1.60–2.35) in March 2007. We found that mortality decreased only modestly each year (mortality rate ratio: 0.98; 95% CI: 0.95–1.00; <italic>P</italic> = 0.093). The proportion of households with orphans under the age of 16 years decreased from 17% in 2004 to 7% in 2011. The proportions of respondents who had ever been tested for HIV, had a comprehensive knowledge of HIV, knew where to obtain free ART and reported that a non-pregnant household member was receiving ART gradually increased.</p></sec><sec><title>Conclusion</title><p>The expansion of ART services in Lusaka was not associated with a reduction in all-cause mortality. Coverage, patient adherence and retention may all have to be increased if ART is to have a robust and lasting impact at population level in Lusaka.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Zambie</li></country></list><tree><noCountry><name sortKey="Rathod, Sujit D" sort="Rathod, Sujit D" uniqKey="Rathod S" first="Sujit D" last="Rathod">Sujit D. Rathod</name></noCountry><country name="Zambie"><noRegion><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H" last="Chi">Benjamin H. Chi</name></noRegion><name sortKey="Chilopa, Batista" sort="Chilopa, Batista" uniqKey="Chilopa B" first="Batista" last="Chilopa">Batista Chilopa</name><name sortKey="Kusanthan, Thankian" sort="Kusanthan, Thankian" uniqKey="Kusanthan T" first="Thankian" last="Kusanthan">Thankian Kusanthan</name><name sortKey="Levy, Jens" sort="Levy, Jens" uniqKey="Levy J" first="Jens" last="Levy">Jens Levy</name><name sortKey="Mwaba, Peter" sort="Mwaba, Peter" uniqKey="Mwaba P" first="Peter" last="Mwaba">Peter Mwaba</name><name sortKey="Sikazwe, Izukanji" sort="Sikazwe, Izukanji" uniqKey="Sikazwe I" first="Izukanji" last="Sikazwe">Izukanji Sikazwe</name><name sortKey="Stringer, Jeffrey Sa" sort="Stringer, Jeffrey Sa" uniqKey="Stringer J" first="Jeffrey Sa" last="Stringer">Jeffrey Sa Stringer</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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