Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)
Identifieur interne : 001225 ( Pmc/Checkpoint ); précédent : 001224; suivant : 001226Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)
Auteurs : Georges Reniers [Royaume-Uni] ; Emma Slaymaker [Royaume-Uni] ; Jessica Nakiyingi-Miiro [Ouganda] ; Constance Nyamukapa [Zimbabwe] ; Amelia Catharine Crampin [Royaume-Uni, Malawi] ; Kobus Herbst [Afrique du Sud] ; Mark Urassa [Tanzanie] ; Fred Otieno [Kenya] ; Simon Gregson [Zimbabwe, Royaume-Uni] ; Maquins Sewe [Kenya] ; Denna Michael [Tanzanie] ; Tom Lutalo [Ouganda] ; Victoria Hosegood [Afrique du Sud, Royaume-Uni] ; Ivan Kasamba [Ouganda] ; Alison Price [Royaume-Uni, Malawi] ; Dorean Nabukalu [Ouganda] ; Estelle Mclean [Royaume-Uni] ; Basia Zaba [Royaume-Uni]Source :
- AIDS (London, England) [ 0269-9370 ] ; 2014.
Abstract
Supplemental Digital Content is available in the text
Url:
DOI: 10.1097/QAD.0000000000000496
PubMed: 25406756
PubMed Central: 4251911
Affiliations:
- Afrique du Sud, Kenya, Malawi, Ouganda, Royaume-Uni, Tanzanie, Zimbabwe
- Angleterre, Grand Londres
- Londres
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PMC:4251911Le document en format XML
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<author><name sortKey="Sewe, Maquins" sort="Sewe, Maquins" uniqKey="Sewe M" first="Maquins" last="Sewe">Maquins Sewe</name>
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<author><name sortKey="Michael, Denna" sort="Michael, Denna" uniqKey="Michael D" first="Denna" last="Michael">Denna Michael</name>
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<author><name sortKey="Lutalo, Tom" sort="Lutalo, Tom" uniqKey="Lutalo T" first="Tom" last="Lutalo">Tom Lutalo</name>
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<author><name sortKey="Hosegood, Victoria" sort="Hosegood, Victoria" uniqKey="Hosegood V" first="Victoria" last="Hosegood">Victoria Hosegood</name>
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<author><name sortKey="Kasamba, Ivan" sort="Kasamba, Ivan" uniqKey="Kasamba I" first="Ivan" last="Kasamba">Ivan Kasamba</name>
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<author><name sortKey="Price, Alison" sort="Price, Alison" uniqKey="Price A" first="Alison" last="Price">Alison Price</name>
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<series><title level="j">AIDS (London, England)</title>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS</journal-id>
<journal-id journal-id-type="iso-abbrev">AIDS</journal-id>
<journal-id journal-id-type="publisher-id">AIDS</journal-id>
<journal-title-group><journal-title>AIDS (London, England)</journal-title>
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<issn pub-type="ppub">0269-9370</issn>
<issn pub-type="epub">1473-5571</issn>
<publisher><publisher-name>Lippincott Williams & Wilkins</publisher-name>
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<article-meta><article-id pub-id-type="pmid">25406756</article-id>
<article-id pub-id-type="pmc">4251911</article-id>
<article-id pub-id-type="doi">10.1097/QAD.0000000000000496</article-id>
<article-id pub-id-type="art-access-id">00015</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>The 2013/14 UNAIDS Estimates Methods: Extending The Scope and Granularity of HIV Estimates</subject>
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<title-group><article-title>Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)</article-title>
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</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Otieno</surname>
<given-names>Fred</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>g</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gregson</surname>
<given-names>Simon</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>c</sup>
</xref>
<xref ref-type="aff" rid="aff8"><sup>h</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sewe</surname>
<given-names>Maquins</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>g</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Michael</surname>
<given-names>Denna</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>f</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lutalo</surname>
<given-names>Tom</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>i</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hosegood</surname>
<given-names>Victoria</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>e</sup>
</xref>
<xref ref-type="aff" rid="aff10"><sup>j</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kasamba</surname>
<given-names>Ivan</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Price</surname>
<given-names>Alison</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
<xref ref-type="aff" rid="aff4"><sup>d</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nabukalu</surname>
<given-names>Dorean</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>i</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mclean</surname>
<given-names>Estelle</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zaba</surname>
<given-names>Basia</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
<on-behalf-of>on behalf of the ALPHA Network</on-behalf-of>
</contrib>
</contrib-group>
<aff id="aff1"><label>a</label>
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK</aff>
<aff id="aff2"><label>b</label>
Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda</aff>
<aff id="aff3"><label>c</label>
Manicaland HIV/STD prevention project, Bio-medical Research and Training Institute, Harare, Zimbabwe</aff>
<aff id="aff4"><label>d</label>
Karonga Prevention Study, London School of Hygiene and Tropical Medicine, Chilumba, Malawi</aff>
<aff id="aff5"><label>e</label>
Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Africa</aff>
<aff id="aff6"><label>f</label>
TAZAMA project, National Institute for Medical Research, Mwanza, Tanzania</aff>
<aff id="aff7"><label>g</label>
Kenya Medical Research Institute / Centers for Disease Control and Prevention, Kisumu, Kenya</aff>
<aff id="aff8"><label>h</label>
School of Public Health, Faculty of Medicine, Imperial College, London, UK</aff>
<aff id="aff9"><label>i</label>
Rakai Health Sciences Program, Makerere University School of Public Health, Rakai, Uganda</aff>
<aff id="aff10"><label>j</label>
Department of Social Statistics and Demography, Southampton University, Southampton, UK.</aff>
<author-notes><corresp>Correspondence to Georges Reniers. E-mail: <email>georges.reniers@lshtm.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>11</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>20</day>
<month>11</month>
<year>2014</year>
</pub-date>
<volume>28</volume>
<issue>4</issue>
<fpage>S533</fpage>
<lpage>S542</lpage>
<history><date date-type="received"><day>22</day>
<month>9</month>
<year>2014</year>
</date>
<date date-type="rev-recd"><day>22</day>
<month>9</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>22</day>
<month>9</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins</copyright-statement>
<copyright-year>2014</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0">http://creativecommons.org/licenses/by-nc-nd/4.0</ext-link>
</license-p>
</license>
</permissions>
<self-uri xlink:type="simple" xlink:href="aids-28-s533.pdf"></self-uri>
<abstract abstract-type="toc"><p>Supplemental Digital Content is available in the text</p>
</abstract>
<abstract><sec sec-type="background"><title>Background:</title>
<p>The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare.</p>
</sec>
<sec sec-type="methods"><title>Methods:</title>
<p>We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15–64) for the period 2000–2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART.</p>
</sec>
<sec sec-type="results"><title>Results:</title>
<p>The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART.</p>
</sec>
<sec sec-type="conclusion"><title>Conclusion:</title>
<p>The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to women's greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease.</p>
</sec>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>antiretroviral therapy (ART)</kwd>
<kwd>HIV</kwd>
<kwd>mortality</kwd>
<kwd>sub-Saharan Africa</kwd>
<kwd>surveillance</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name>
<meta-value>TRUE</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<floats-group><table-wrap id="T1" position="float"><label>Table 1</label>
<caption><p>Site-specific characteristics of the study populations, and HIV+/HIV− mortality rate ratios.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><td colspan="2" rowspan="1">Study site, country</td>
<td colspan="4" rowspan="1">Individuals, person-years and deaths by HIV status</td>
<td colspan="2" rowspan="1">Mortality Rates and RR</td>
<td colspan="2" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td colspan="2" rowspan="1">2000–2003</td>
<td colspan="2" rowspan="1">2009–2011</td>
</tr>
<tr><td rowspan="1" colspan="1">Dates, all-cause mortality Dates, mortality by HIV</td>
<td rowspan="1" colspan="1">Average HIV%<xref ref-type="table-fn" rid="TF1-1"><sup>a</sup>
</xref>
</td>
<td rowspan="1" colspan="1">HIV status</td>
<td rowspan="1" colspan="1">Individuals (ages 15–64)</td>
<td rowspan="1" colspan="1">Person-years</td>
<td rowspan="1" colspan="1">Deaths</td>
<td rowspan="1" colspan="1">Death rate (per 1000)</td>
<td rowspan="1" colspan="1">HIV+/HIV– RR (95% CI)</td>
<td rowspan="1" colspan="1">Death rate (per 1000)</td>
<td rowspan="1" colspan="1">HIV+/HIV– RR (95% CI)</td>
</tr>
</thead>
<tbody><tr><td rowspan="1" colspan="1">Karonga, MAW</td>
<td rowspan="1" colspan="1">11.3</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">30 397</td>
<td rowspan="1" colspan="1">144 479</td>
<td rowspan="1" colspan="1">1486</td>
<td rowspan="1" colspan="1">14.6</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">7.6</td>
<td rowspan="1" colspan="1">3.9</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2003–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV−</td>
<td rowspan="1" colspan="1">17 156</td>
<td rowspan="1" colspan="1">47 204</td>
<td rowspan="1" colspan="1">230</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">5.3</td>
<td rowspan="1" colspan="1">(3.0–5.1)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2006–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">1761</td>
<td rowspan="1" colspan="1">5320</td>
<td rowspan="1" colspan="1">149</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">20.8</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">29 384</td>
<td rowspan="1" colspan="1">91 955</td>
<td rowspan="1" colspan="1">1107</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">10.8</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Kisesa, TAZ</td>
<td rowspan="1" colspan="1">5.9</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">45 540</td>
<td rowspan="1" colspan="1">171 619</td>
<td rowspan="1" colspan="1">1791</td>
<td rowspan="1" colspan="1">12.5</td>
<td rowspan="1" colspan="1">8.4</td>
<td rowspan="1" colspan="1">8.0</td>
<td rowspan="1" colspan="1">5.3</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV–</td>
<td rowspan="1" colspan="1">18 192</td>
<td rowspan="1" colspan="1">82 108</td>
<td rowspan="1" colspan="1">697</td>
<td rowspan="1" colspan="1">9.1</td>
<td rowspan="1" colspan="1">(6.7–10.7)</td>
<td rowspan="1" colspan="1">7.0</td>
<td rowspan="1" colspan="1">(3.8–7.3)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">1507</td>
<td rowspan="1" colspan="1">4750</td>
<td rowspan="1" colspan="1">275</td>
<td rowspan="1" colspan="1">76.9</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">36.9</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">40 018</td>
<td rowspan="1" colspan="1">84 761</td>
<td rowspan="1" colspan="1">819</td>
<td rowspan="1" colspan="1">12.3</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">7.4</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Kisumu, KEN</td>
<td rowspan="1" colspan="1">24.6</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">229 177</td>
<td rowspan="1" colspan="1">901 590</td>
<td rowspan="1" colspan="1">17 289</td>
<td rowspan="1" colspan="1">25.6</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">15.0</td>
<td rowspan="1" colspan="1">2.6</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2003–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV–</td>
<td rowspan="1" colspan="1">68 128</td>
<td rowspan="1" colspan="1">110 874</td>
<td rowspan="1" colspan="1">1369</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">12.4</td>
<td rowspan="1" colspan="1">(2.4–2.8)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2008–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">13 901</td>
<td rowspan="1" colspan="1">32 153</td>
<td rowspan="1" colspan="1">1752</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">32.3</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">222 641</td>
<td rowspan="1" colspan="1">758 564</td>
<td rowspan="1" colspan="1">14 168</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">14.3</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Manicaland, ZIM</td>
<td rowspan="1" colspan="1">21.9</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">67 225</td>
<td rowspan="1" colspan="1">319 384</td>
<td rowspan="1" colspan="1">3908</td>
<td rowspan="1" colspan="1">16.8</td>
<td rowspan="1" colspan="1">12.3</td>
<td rowspan="1" colspan="1">7.2</td>
<td rowspan="1" colspan="1">6.5</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2010</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV–</td>
<td rowspan="1" colspan="1">28 330</td>
<td rowspan="1" colspan="1">99 621</td>
<td rowspan="1" colspan="1">579</td>
<td rowspan="1" colspan="1">4.7</td>
<td rowspan="1" colspan="1">(10.1–15.1)</td>
<td rowspan="1" colspan="1">4.3</td>
<td rowspan="1" colspan="1">(5.0–8.6)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2010</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">6604</td>
<td rowspan="1" colspan="1">29 861</td>
<td rowspan="1" colspan="1">1406</td>
<td rowspan="1" colspan="1">58.5</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">28.1</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">59 060</td>
<td rowspan="1" colspan="1">189 903</td>
<td rowspan="1" colspan="1">1923</td>
<td rowspan="1" colspan="1">16.8</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">5.7</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Masaka, UGA</td>
<td rowspan="1" colspan="1">9.4</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">21 999</td>
<td rowspan="1" colspan="1">105 860</td>
<td rowspan="1" colspan="1">1412</td>
<td rowspan="1" colspan="1">16.4</td>
<td rowspan="1" colspan="1">8.5</td>
<td rowspan="1" colspan="1">10.7</td>
<td rowspan="1" colspan="1">2.6</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV–</td>
<td rowspan="1" colspan="1">17 342</td>
<td rowspan="1" colspan="1">81 138</td>
<td rowspan="1" colspan="1">772</td>
<td rowspan="1" colspan="1">10.6</td>
<td rowspan="1" colspan="1">(7–10.2)</td>
<td rowspan="1" colspan="1">8.6</td>
<td rowspan="1" colspan="1">(1.9–3.6)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">1873</td>
<td rowspan="1" colspan="1">7753</td>
<td rowspan="1" colspan="1">390</td>
<td rowspan="1" colspan="1">90.0</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">22.7</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">11 221</td>
<td rowspan="1" colspan="1">16 970</td>
<td rowspan="1" colspan="1">250</td>
<td rowspan="1" colspan="1">14.1</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">14.9</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Rakai, UGA</td>
<td rowspan="1" colspan="1">12.5</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">67 909</td>
<td rowspan="1" colspan="1">296 723</td>
<td rowspan="1" colspan="1">3668</td>
<td rowspan="1" colspan="1">16.9</td>
<td rowspan="1" colspan="1">21.2</td>
<td rowspan="1" colspan="1">9.2</td>
<td rowspan="1" colspan="1">6.6</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2010</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV−</td>
<td rowspan="1" colspan="1">34 331</td>
<td rowspan="1" colspan="1">148 308</td>
<td rowspan="1" colspan="1">559</td>
<td rowspan="1" colspan="1">4.5</td>
<td rowspan="1" colspan="1">(18.2–24.6)</td>
<td rowspan="1" colspan="1">3.4</td>
<td rowspan="1" colspan="1">(5.0–8.8)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2000–2010</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">5538</td>
<td rowspan="1" colspan="1">20 493</td>
<td rowspan="1" colspan="1">1210</td>
<td rowspan="1" colspan="1">96.2</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">22.5</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">59 194</td>
<td rowspan="1" colspan="1">127 922</td>
<td rowspan="1" colspan="1">1899</td>
<td rowspan="1" colspan="1">18.5</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">13.8</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">uMkhanyakude, RSA</td>
<td rowspan="1" colspan="1">35.4</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">88 230</td>
<td rowspan="1" colspan="1">467 619</td>
<td rowspan="1" colspan="1">9560</td>
<td rowspan="1" colspan="1">22.7</td>
<td rowspan="1" colspan="1">9.5</td>
<td rowspan="1" colspan="1">16.4</td>
<td rowspan="1" colspan="1">2.4</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2001–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV−</td>
<td rowspan="1" colspan="1">26 294</td>
<td rowspan="1" colspan="1">76 450</td>
<td rowspan="1" colspan="1">791</td>
<td rowspan="1" colspan="1">7.4</td>
<td rowspan="1" colspan="1">(4.4–20.6)</td>
<td rowspan="1" colspan="1">15.1</td>
<td rowspan="1" colspan="1">(2.1–2.7)</td>
</tr>
<tr><td rowspan="1" colspan="1"> 2004–2011</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">12 314</td>
<td rowspan="1" colspan="1">37 565</td>
<td rowspan="1" colspan="1">1711</td>
<td rowspan="1" colspan="1">69.9</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">36.0</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">87 791</td>
<td rowspan="1" colspan="1">353 603</td>
<td rowspan="1" colspan="1">7058</td>
<td rowspan="1" colspan="1">22.7</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">11.5</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Total</td>
<td rowspan="1" colspan="1">18.5</td>
<td rowspan="1" colspan="1">All</td>
<td rowspan="1" colspan="1">550 477</td>
<td rowspan="1" colspan="1">2407,275</td>
<td rowspan="1" colspan="1">39 114</td>
<td rowspan="1" colspan="1">19.4</td>
<td rowspan="1" colspan="1">11.6</td>
<td rowspan="1" colspan="1">12.9</td>
<td rowspan="1" colspan="1">3.3</td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV−</td>
<td rowspan="1" colspan="1">209 773</td>
<td rowspan="1" colspan="1">645 704</td>
<td rowspan="1" colspan="1">4997</td>
<td rowspan="1" colspan="1">6.7</td>
<td rowspan="1" colspan="1">(10.7–12.7)</td>
<td rowspan="1" colspan="1">9.5</td>
<td rowspan="1" colspan="1">(3.1–3.5)</td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV+</td>
<td rowspan="1" colspan="1">43 498</td>
<td rowspan="1" colspan="1">137 894</td>
<td rowspan="1" colspan="1">6893</td>
<td rowspan="1" colspan="1">77.8</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">31.6</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">HIV unknown<xref ref-type="table-fn" rid="TF1-2"><sup>b</sup>
</xref>
</td>
<td rowspan="1" colspan="1">509 309</td>
<td rowspan="1" colspan="1">1623 677</td>
<td rowspan="1" colspan="1">27 224</td>
<td rowspan="1" colspan="1">21.0</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">12.2</td>
<td rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn fn-type="other"><p>CI, confidence interval; KEN, Kenya; MAW, Malawi; ND, no data; RR, rate ratio; RSA, South Africa; TAZ, Tanzania; UGA, Uganda; ZIM, Zimbabwe.</p>
</fn>
<fn id="TF1-1"><p><sup>a</sup>
Average HIV prevalence = HIV+ person-years/(HIV+ person-years + HIV− person-years). These prevalence estimates are relatively high because we include HIV status information from medical facilities and treatment clinics, which increases the fraction of known HIV positives in our dataset.</p>
</fn>
<fn id="TF1-2"><p><sup>b</sup>
HIV unknown includes all the persons-years of exposure before the start of the HIV surveillance in the study site, and individual time prior to first HIV test.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" position="float"><label>Table 2</label>
<caption><p>All-cause mortality in HIV-positive individuals, hazard ratios and 95% confidence interval (Weibull regression).</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><td rowspan="1" colspan="1">Study site – Country code</td>
<td rowspan="1" colspan="1">Karonga – MAW</td>
<td rowspan="1" colspan="1">Kisesa – TAZ</td>
<td rowspan="1" colspan="1">Kisumu – KEN</td>
<td rowspan="1" colspan="1">Manicaland – ZIM</td>
<td rowspan="1" colspan="1">Masaka – UGA</td>
<td rowspan="1" colspan="1">Rakai – UGA</td>
<td rowspan="1" colspan="1">uMkhanyakude – RSA</td>
</tr>
<tr><td rowspan="1" colspan="1">Pre-ART period</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">2000–2004</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">2000–2004</td>
<td rowspan="1" colspan="1">2000–2003</td>
<td rowspan="1" colspan="1">2000–2003</td>
<td rowspan="1" colspan="1">2004</td>
</tr>
</thead>
<tbody><tr><td rowspan="1" colspan="1">Calendar year (annual change)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">0.95 (0.84–1.06)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">1.09 (1.03–1.16)</td>
<td rowspan="1" colspan="1">0.88 (0.78–1.00)</td>
<td rowspan="1" colspan="1">1.05 (0.98–1.13)</td>
<td rowspan="1" colspan="1">ND</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td colspan="8" rowspan="1">Women (ref.)</td>
</tr>
<tr><td rowspan="1" colspan="1">Male</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">1.16 (0.82–1.63)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">1.03 (0.87–1.22)</td>
<td rowspan="1" colspan="1">0.98 (0.73–1.31)</td>
<td rowspan="1" colspan="1">1.01 (0.86–1.19)</td>
<td rowspan="1" colspan="1">ND</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Interaction: male x calendar year</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">ND</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">p (age)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">2.39 (1.85–3.09)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">2.15 (1.84–2.51)</td>
<td rowspan="1" colspan="1">1.64 (1.18–2.26)</td>
<td rowspan="1" colspan="1">1.79 (1.48–2.15)</td>
<td rowspan="1" colspan="1">ND</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"><italic>N</italic>
</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">868</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">4029</td>
<td rowspan="1" colspan="1">927</td>
<td rowspan="1" colspan="1">3175</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Deaths</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">133</td>
<td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1">583</td>
<td rowspan="1" colspan="1">188</td>
<td rowspan="1" colspan="1">665</td>
<td rowspan="1" colspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Post-ART period</td>
<td rowspan="1" colspan="1">2006–2011</td>
<td rowspan="1" colspan="1">2005–2011</td>
<td rowspan="1" colspan="1">2008–2011</td>
<td rowspan="1" colspan="1">2005–2010</td>
<td rowspan="1" colspan="1">2004–2011</td>
<td rowspan="1" colspan="1">2004–2010</td>
<td rowspan="1" colspan="1">2005–2011</td>
</tr>
<tr><td rowspan="1" colspan="1">Calendar year (annual change)</td>
<td rowspan="1" colspan="1">0.86 (0.75–0.99)</td>
<td rowspan="1" colspan="1">0.87 (0.83–0.92)</td>
<td rowspan="1" colspan="1">0.62 (0.59–0.65)</td>
<td rowspan="1" colspan="1">0.85 (0.83–0.87)</td>
<td rowspan="1" colspan="1">0.80 (0.76–0.84)</td>
<td rowspan="1" colspan="1">0.75 (0.72–0.78)</td>
<td rowspan="1" colspan="1">0.83 (0.80–0.85)</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td colspan="8" rowspan="1">Women (ref.)</td>
</tr>
<tr><td rowspan="1" colspan="1">Men</td>
<td rowspan="1" colspan="1">1.66 (1.14–2.41)</td>
<td rowspan="1" colspan="1">1.29 (1.01–1.65)</td>
<td rowspan="1" colspan="1">2.14 (1.92–2.39)</td>
<td rowspan="1" colspan="1">1.03 (0.93–1.15)</td>
<td rowspan="1" colspan="1">1.09 (0.88–1.34)</td>
<td rowspan="1" colspan="1">0.99 (0.86–1.15)</td>
<td rowspan="1" colspan="1">1.16 (0.90–1.48)</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">Interaction: male x calendar year</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">NS</td>
<td rowspan="1" colspan="1">1.11 (1.05–1.18)</td>
<td rowspan="1" colspan="1">1.09 (1.04–1.14)</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td colspan="8" rowspan="1">No record of ART (ref.)</td>
</tr>
<tr><td rowspan="1" colspan="1">Had ART – early</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">6.23 (4.68–8.29)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">3.11 (1.60–6.04)</td>
<td rowspan="1" colspan="1">0.58 (0.26–1.29)</td>
<td rowspan="1" colspan="1">1.93 (1.06–3.51)</td>
</tr>
<tr><td rowspan="1" colspan="1">Had ART – late</td>
<td rowspan="1" colspan="1">1.78 (1.20–2.65)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">1.07 (0.87–1.30)</td>
<td rowspan="1" colspan="1">ND</td>
<td rowspan="1" colspan="1">1.20 (0.81–1.77)</td>
<td rowspan="1" colspan="1">0.67 (0.49–0.91)</td>
<td rowspan="1" colspan="1">1.39 (1.24–1.56)</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1">p (age)</td>
<td rowspan="1" colspan="1">1.72 (1.09–2.72)</td>
<td rowspan="1" colspan="1">2.19 (1.79–2.69)</td>
<td rowspan="1" colspan="1">1.43 (1.25–1.63)</td>
<td rowspan="1" colspan="1">2.06 (1.86–2.29)</td>
<td rowspan="1" colspan="1">1.57 (1.23–2.01)</td>
<td rowspan="1" colspan="1">1.97 (1.73–2.23)</td>
<td rowspan="1" colspan="1">2.15 (1.98–2.34)</td>
</tr>
<tr><td colspan="8" rowspan="1"></td>
</tr>
<tr><td rowspan="1" colspan="1"><italic>N</italic>
</td>
<td rowspan="1" colspan="1">1672</td>
<td rowspan="1" colspan="1">1488</td>
<td rowspan="1" colspan="1">13193</td>
<td rowspan="1" colspan="1">6824</td>
<td rowspan="1" colspan="1">1813</td>
<td rowspan="1" colspan="1">5535</td>
<td rowspan="1" colspan="1">12129</td>
</tr>
<tr><td rowspan="1" colspan="1">Deaths</td>
<td rowspan="1" colspan="1">111</td>
<td rowspan="1" colspan="1">266</td>
<td rowspan="1" colspan="1">1347</td>
<td rowspan="1" colspan="1">1406</td>
<td rowspan="1" colspan="1">358</td>
<td rowspan="1" colspan="1">1208</td>
<td rowspan="1" colspan="1">1633</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn fn-type="other"><p>Estimates from site-specific and period-specific regression models. The analysis of the pre-ART period is restricted to the study sites that conducted population-based HIV serosurveys before the local introduction of ART. Pre-ART years, where available, contribute to the analyses for the post-ART period but are all coded 0; starting with the year wherein ART was first made locally available, the following calendar years are coded with consecutive numbers. ART, antiretroviral therapy; KEN, Kenya; MAW, Malawi; ND, no data to estimate coefficient(s); ref., reference category; RSA, South Africa; TAZ, Tanzania; UGA, Uganda; ZIM, Zimbabwe.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Kenya</li>
<li>Malawi</li>
<li>Ouganda</li>
<li>Royaume-Uni</li>
<li>Tanzanie</li>
<li>Zimbabwe</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
</region>
<settlement><li>Londres</li>
</settlement>
</list>
<tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Reniers, Georges" sort="Reniers, Georges" uniqKey="Reniers G" first="Georges" last="Reniers">Georges Reniers</name>
</region>
<name sortKey="Crampin, Amelia Catharine" sort="Crampin, Amelia Catharine" uniqKey="Crampin A" first="Amelia Catharine" last="Crampin">Amelia Catharine Crampin</name>
<name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name>
<name sortKey="Hosegood, Victoria" sort="Hosegood, Victoria" uniqKey="Hosegood V" first="Victoria" last="Hosegood">Victoria Hosegood</name>
<name sortKey="Mclean, Estelle" sort="Mclean, Estelle" uniqKey="Mclean E" first="Estelle" last="Mclean">Estelle Mclean</name>
<name sortKey="Price, Alison" sort="Price, Alison" uniqKey="Price A" first="Alison" last="Price">Alison Price</name>
<name sortKey="Slaymaker, Emma" sort="Slaymaker, Emma" uniqKey="Slaymaker E" first="Emma" last="Slaymaker">Emma Slaymaker</name>
<name sortKey="Zaba, Basia" sort="Zaba, Basia" uniqKey="Zaba B" first="Basia" last="Zaba">Basia Zaba</name>
</country>
<country name="Ouganda"><noRegion><name sortKey="Nakiyingi Miiro, Jessica" sort="Nakiyingi Miiro, Jessica" uniqKey="Nakiyingi Miiro J" first="Jessica" last="Nakiyingi-Miiro">Jessica Nakiyingi-Miiro</name>
</noRegion>
<name sortKey="Kasamba, Ivan" sort="Kasamba, Ivan" uniqKey="Kasamba I" first="Ivan" last="Kasamba">Ivan Kasamba</name>
<name sortKey="Lutalo, Tom" sort="Lutalo, Tom" uniqKey="Lutalo T" first="Tom" last="Lutalo">Tom Lutalo</name>
<name sortKey="Nabukalu, Dorean" sort="Nabukalu, Dorean" uniqKey="Nabukalu D" first="Dorean" last="Nabukalu">Dorean Nabukalu</name>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name>
</noRegion>
<name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name>
</country>
<country name="Malawi"><noRegion><name sortKey="Crampin, Amelia Catharine" sort="Crampin, Amelia Catharine" uniqKey="Crampin A" first="Amelia Catharine" last="Crampin">Amelia Catharine Crampin</name>
</noRegion>
<name sortKey="Price, Alison" sort="Price, Alison" uniqKey="Price A" first="Alison" last="Price">Alison Price</name>
</country>
<country name="Afrique du Sud"><noRegion><name sortKey="Herbst, Kobus" sort="Herbst, Kobus" uniqKey="Herbst K" first="Kobus" last="Herbst">Kobus Herbst</name>
</noRegion>
<name sortKey="Hosegood, Victoria" sort="Hosegood, Victoria" uniqKey="Hosegood V" first="Victoria" last="Hosegood">Victoria Hosegood</name>
</country>
<country name="Tanzanie"><noRegion><name sortKey="Urassa, Mark" sort="Urassa, Mark" uniqKey="Urassa M" first="Mark" last="Urassa">Mark Urassa</name>
</noRegion>
<name sortKey="Michael, Denna" sort="Michael, Denna" uniqKey="Michael D" first="Denna" last="Michael">Denna Michael</name>
</country>
<country name="Kenya"><noRegion><name sortKey="Otieno, Fred" sort="Otieno, Fred" uniqKey="Otieno F" first="Fred" last="Otieno">Fred Otieno</name>
</noRegion>
<name sortKey="Sewe, Maquins" sort="Sewe, Maquins" uniqKey="Sewe M" first="Maquins" last="Sewe">Maquins Sewe</name>
</country>
</tree>
</affiliations>
</record>
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