The population effect of ART on mortality during an eight year period of decentralised ART care in Malawi; rates in those accessing ART and those not accessing ART

Price, Alison

The population effect of ART on mortality during an eight year period of decentralised ART care in Malawi; rates in those accessing ART and those not accessing ART

Monday, 18 August 2014: 5:15 PM

Ballroom C (Dena'ina Center)

Alison Price, PhD , London School of Hygiene and Tropical Medicine, London, United Kingdom

Menard Chihana, MS , Karonga Prevention Study, Chilumba, Malawi

Ndoliwe Kayuni, MS , Karonga Prevention Study, Chilumba, Malawi

Judith R Glynn, PhD , London School of Hygiene and Tropical Medicine, London, United Kingdom

Themba Mzembe, BA , Karonga Prevention Study, Chilumba, Malawi

Emma Slaymaker, PhD , London School of Hygiene and Tropical Medicine, London, United Kingdom

Basia Zaba, MS , London School of Hygiene and Tropical Medicine, London, United Kingdom

Neil French, PhD , University of Liverpool, Liverpool, United Kingdom

Fredrick Kalobekamo , Karonga Prevention Study, Chilumba, Malawi

Amelia C Crampin, MD , London School of Hygiene and Tropical Medicine, London, United Kingdom

INRODUCTION:Improved life expectancy amongst HIV positive individuals and in high HIV prevalence populations have been observed since the scale-up and de-centralisation of ART programmes. However, at a population-level, trends in mortality among HIV positive individuals on the care and treatment continuum are not well described.

METHODS: Individual-level demographic data and HIV test results from the Karonga Prevention Study surveillance site in northern rural Malawi were linked with ART clinic data for the eight year period (2005-2012) of ART scale-up. Life expectancy (Kaplan Meier) and mortality rate ratios (Poisson regression) were calculated by time period, stratified by HIV status, ART use, sex and age group, adjusting for confounders.

RESULTS: During 8 years of follow-up there were 1,210 adult deaths. Population life expectancy of 15-year olds increased from 48.7 to 55.1 years. Age-standardised adult mortality rates were 11.1/1000 person years (py) in 2005-2008 and 7.8/1000 py in 2009-2012. Mortality in HIV-negative individuals did not change significantly (2.58/1000 py in 2009-2012 vs 2.59/1000 py in 2005-2008; adjusted hazard ratio (HR) 0.99; 95% CI 0.62, 1.38) but in HIV positive individuals, mortality was lower in 2009-2012 than in 2005-2008, both in those on ART (30.9/1000 py in 2009-2012 vs 65.1/1000 py in 2005-2008; adjusted HR 0.47; 95% CI 0.32, 0.68; p<0.0001) and in those who had not (yet) used ART (12.4/1000 py in 2009-2012 vs 44.1/1000 py in 2005-2008; adjusted HR 0.27; 95% CI 0.16, 0.44; p<0.0001).

CONCLUSION: Large reductions in adult mortality and increasing adult life expectancy have been achieved in rural Malawi over an 8 year period of increasing decentralisation of ART care. The reduction in mortality among those not yet on ART demonstrates the success of the ART programme, in identifying treatment need of HIV infected individuals at an earlier stage of disease, though as the mortality rate is still higher than that in the HIV negatives there is scope for further improvement.