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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia
AIDS, Volume 23, No. 4, Year 2009
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Description
Objectives: Assessments of population-level effects of antiretroviral therapy (ART) programmes in Africa are rare. We use data from burial sites to estimate trends in adult AIDS mortality and the mitigating effects of ART in Addis Ababa. ART has been available since 2003, and for free since 2005. Methods: To substitute for deficient vital registration, we use surveillance of burials at all cemeteries. We present trends in all-cause mortality, and estimate AIDS mortality (ages 20-64 years) from lay reports of causes of death. These lay reports are first used as a diagnostic test for the true cause of death. As reference standard, we use the cause of death established via verbal autopsy interviews conducted in 2004. The positive predictive value and sensitivity are subsequently used as anchors to estimate the number of AIDS deaths for the period 2001-2007. Estimates are compared with Spectrum projections. Results: Between 2001 and 2005, the number of AIDS deaths declined by 21.9 and 9.3% for men and women, respectively. Between 2005 and 2007, the number of AIDS deaths declined by 38.2 for men and 42.9% for women. Compared with the expected number in the absence of ART, the reduction in AIDS deaths in 2007 is estimated to be between 56.8 and 63.3%, depending on the coverage of the burial surveillance. Conclusion: Five years into the ART programme, adult AIDS mortality has been reduced by more than half. Following the free provision of ART in 2005, the decline accelerated and became more sex balanced. Substantial AIDS mortality, however, persists. © 2009 Wolters Kluwer Health|Lippincott Williams & Wilkins.
Authors & Co-Authors
Reniers, Georges
United States, Boulder
University of Colorado Boulder
South Africa, Johannesburg
University of the Witwatersrand
United States, Princeton
Princeton School of Public and International Affairs
Araya, Tekebash
Ethiopia, Addis Ababa
Addis Ababa University
Davey, G. J.G.
Ethiopia, Addis Ababa
Addis Ababa University
Nagelkerke, Nico J.D.
United Arab Emirates, Al Ain
United Arab Emirates University
Berhane, Yemane
Ethiopia, Addis Ababa
Addis Ababa University
Ethiopia, Addis Ababa
Addis Continental Institute of Public Health
Coutinho, Roel A.
Netherlands, Bilthoven
Rijksinstituut Voor Volksgezondheid en Milieu
Netherlands, Amsterdam
Universiteit Van Amsterdam
Sanders, Eduard Joachim
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Statistics
Citations: 101
Authors: 7
Affiliations: 10
Identifiers
Doi:
10.1097/QAD.0b013e32832403d0
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Ethiopia
Participants Gender
Male
Female