Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda.
Nabukalu D., Reniers G., Risher KA., Blom S., Slaymaker E., Kabudula C., Zaba B., Nalugoda F., Kigozi G., Makumbi F., Serwadda D., Reynolds SJ., Marston M., Eaton JW., Gray R., Wawer M., Sewankambo N., Lutalo T.
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.