The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: A longitudinal population-based study, 1999-2009

Abstract

Objective To investigate trends in all-cause adult mortality after the roll-out of an antiretroviral therapy (ART) programme in rural Uganda. Methods Longitudinal population-based cohort study of approximately 20000 residents in rural Uganda. Mortality in adults aged 15-59years was determined for the 5-year period (1999-2003) before introduction of ART in January 2004 and for the 5-year period afterwards. Poisson regression was used to estimate mortality rate ratios (RRs) for the period before ART, 1year after ART introduction (from January 2004 to January 2005) and more than 1year after ART introduction. Trends in mortality were analysed by HIV status, age and sex. Results Before ART became available, the mortality rate (deaths per 1000 person-years) was 4.0 (95% CI=3.3-4.8) among HIV-negative individuals and 116.4 (95% CI=101.9-133.0) among HIV-positive individuals. During the period January 2004-end November 2009, 279 individuals accessed ART. In the year after ART was introduced, the mortality rate (deaths per 1000 person-years) among HIV-negative individuals did not change significantly (adjusted RR=0.95, 95% CI=0.61-1.47), but among HIV-positive individuals dropped by 25% to 87.4 (adjusted RR=0.75, 95% CI=0.53-1.06). In the period 2005-2009, the mortality rate (deaths per 1000 person-years) among HIV-positive individuals fell further to 39.9 (adjusted RR=0.33, 95% CI=0.26-0.43). The effect was greatest among individuals aged 30-44years, and trends were similar in men and women. Conclusion The substantially reduced mortality rate among HIV-positive individuals after ART roll-out lends further support to the intensification of efforts to ensure universal access to ART. © 2012 Blackwell Publishing Ltd.