Evidence map›Paper›PMID 27956187›Full record

Observational studyThe lancet. HIV2017

Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study.

Georges Reniers, Sylvia Blom, Clara Calvert, Alexandra Martin-Onraet, Abraham J Herbst, Jeffrey W Eaton, Jacob Bor, Emma Slaymaker, Zehang R Li, Samuel J Clark and 3 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The lancet. HIV, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

44 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Georges ReniersDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: georges.reniers@lshtm.ac.uk.
Sylvia BlomDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Clara CalvertDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Alexandra Martin-OnraetInstituto Nacional de Cancerología, Mexico City, Mexico.
Abraham J HerbstAfrica Health Research Institute, Durban, South Africa.
Jeffrey W EatonDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Jacob BorDepartment of Global Health, Boston University, Boston, MA, USA.
Emma SlaymakerDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Zehang R LiDepartment of Statistics, University of Washington, Seattle, WA, USA.
Samuel J ClarkSchool of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Sociology, The Ohio State University, Columbus, OH, USA.
Till BärnighausenAfrica Health Research Institute, Durban, South Africa; Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
Basia ZabaDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Victoria HosegoodAfrica Health Research Institute, Durban, South Africa; Social Statistics and Demography, University of Southampton, Southampton, UK.

Funding

SOCIAL AND ECONOMIC PREDICTORS OF PHYSICAL AND COGNITIVE FUNCTIONP01AG041710 · NIA · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Stephen Tollman · 2013 to 2026
$37.3M
Training Tanzanian Researchers for HIV/AIDS Implementation ScienceD43TW009775 · FIC · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Wafaie W Fawzi, Christopher Sudfeld · 2015 to 2026
$3.0M
New Methods for the design and evaluation of large HIV prevention interventionsR01AI112339 · NIAID · YALE UNIVERSITY · PI SPIEGELMAN, DONNA L · 2014 to 2017
$2.7M
Causal Pathways to population health impact of HIV antiretroviral treatmentR01HD084233 · NICHD · UNIVERSITY OF KWAZULU-NATAL · PI BARNIGHAUSEN, TILL, TANSER, FRANK COURTENEY · 2015 to 2021
$2.3M
Can HIV Hot-Spots be eradicated? An intervention to decrease HIV transmission to young women in rural KwaZulu-Natal South AfricaR01AI124389 · NIAID · UNIVERSITY OF KWAZULU-NATAL · PI BARNIGHAUSEN, TILL, TANSER, FRANK COURTENEY · 2016 to 2020
$2.1M
Understanding causal pathways of HIV acquisition and transmission: a multi-level,R01HD058482 · NICHD · UNIVERSITY OF KWAZULU-NATAL · PI BARNIGHAUSEN, TILL, TANSER, FRANK COURTENEY · 2008 to 2012
$1.2M
Economic, health, and behavioral dimensions of HIV treatment scale-upK01MH105320 · NIMH · BOSTON UNIVERSITY MEDICAL CAMPUS · PI BOR, JACOB · 2015 to 2018
$613k
FIC NIH HHS D43 TW009775NIAID NIH HHS R01 AI112339NIAID NIH HHS R01 AI124389NIA NIH HHS P01 AG041710NICHD NIH HHS R01 HD058482NICHD NIH HHS R01 HD084233NIMH NIH HHS K01 MH105320Wellcome Trust
6 · The paper itself

Abstract

backgroundAntiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world.

methodsData come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods.

findingsCovering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women.

interpretationThe burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better engagement with HIV-care services. Gains in adult life-years lived as well as the present life expectancy deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary tuberculosis.

fundingWellcome Trust, the Bill & Melinda Gates Foundation, and the National Institutes of Health.

Indexed as

Cost of IllnessAdolescentAdultCohort StudiesEpidemicsFemaleGlobal HealthHIV InfectionsHumansLife ExpectancyMaleMiddle AgedRisk FactorsRural HealthSex DistributionSex Factors

Identifiers

PMID27956187
PMCPMC5405557

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.