Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa

<p>Objective To investigate trends in adult mortality in a population serviced by a public?sector antiretroviral therapy (ART) programme inrural South Africa using a demographic surveillance system.Methods Verbal autopsies were conducted for all 7930 deaths observed between January 2000 and December 2006 in ademographic surveillance population of 74 500 in the Umkhanyakude district of northern KwaZulu?Natal province, South Africa.Age?standardized mortality rate ratios (SMRRs) were calculated for adults aged 25 to 49 years, the group most affected by HIV,for the 2 years before 2004 and the 3 subsequent years, during which ART had been available.Findings Between 2002–2003 (the period before ART) and 2004–2006 (the period after ART), HIV?related age?standardizedmortality declined significantly, from 22.52 to 17.58 per 1000 person?years in women 25–49 years of age (P < 0.001; SMRR: 0.780;95% confidence interval, CI: 0.691–0.881), and from 26.46 to 18.68 per 1000 person?years in men 25–49 years of age (P < 0.001;SMRR: 0.706; 95% CI: 0.615–0.811). On sensitivity analysis the results were robust to the possible effect of misclassification ofHIV?related deaths.Conclusion Overall population mortality and HIV?related adult mortality declined significantly following ART roll?out in a communitywith a high prevalence of HIV infection. A clear public health message of the benefits of treatment, as revealed by these findings,should be part of a multi?faceted strategy to encourage people to find out their HIV serostatus and seek care.</p>