Adult Mortality in East and Southern Africa in the Era of Antiretroviral Therapy

Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Emma Slaymaker, London School of Hygiene and Tropical Medicine (LSHTM)
Basia Zaba, London School of Hygiene and Tropical Medicine (LSHTM)

Monitoring the impact of AIDS and the mitigating effects of interventions in developing countries is notoriously difficult because populations that are hardest hit by the epidemic tend to have poor vital events registration. In this contribution, we use data from seven demographic surveillance sites with repeated testing for HIV and continuous monitoring of mortality. These studies also collect self-reported and/or facility data on ART uptake and establish causes of death via verbal autopsy. We use survival analysis techniques to study the time to diagnosis following seroconversion (with death as a competing risk), the time to ART initiation following diagnosis (with death as a competing risk), and death following ART uptake. We disaggregate these analyses by sex, region, and (seroconversion, diagnosis or treatment) cohort. Preliminary results suggest that HIV testing and ART coverage are have increased rapidly. Despite delayed ART scale-up, Southern African sites now achieve better treatment coverage and lower mortality on treatment than Eastern African sites.