Dramatic Reduction in Mortality Rates due to HIV treatment scale-up in rural KwaZulu-Natal

Dr Till Barnighausen and Dr Jacob Bor.

The study measured trends in adult life expectancy between 2000 and 2011 among 101,000 individuals in an area of Umkhanyakude District, KwaZulu-Natal. The community is largely rural and 29% of adults were HIV positive in 2011. In the early 2000’s, adult life expectancy in this community declined considerably, reaching 49.2 years in 2003. However, following the scale-up of antiretroviral treatment (ART) in public sector clinics and hospitals in 2004, adult life expectancy began to increase, reaching 60.5 years by 2011.

‘We have known for many years that ART prolongs the lives of people with HIV, but the impact of ART scale-up on adult life expectancy at the population level hadn’t previously been measured, said the study’s lead author, Dr Jacob Bor, of the Africa Centre and Harvard School of Public Health. The public sector scale-up of ART has transformed health in this community, Bor said. Before ART became widely available, most people were dying in their 30s and 40s. Now people are living to pension age and beyond.’

Even with these large gains in adult life expectancy, the authors still found evidence of excess HIV-related mortality among younger adults, aged 15-45 years. ‘As this study shows, providing ART at scale in settings with high HIV prevalence has had very large impacts on adult life expectancy at the population level. Further expansion of treatment access, recruitment, and retention, as well as further investments in circumcision and other HIV interventions to reduce the spread of HIV are likely to achieve additional gains in adult life expectancy,’ said Dr Till Bärnighausen, Senior Epidemiologist at the Africa Centre.