HIV/AIDS-related mortality in Africa and Asia: Evidence from INDEPTH health and demographic surveillance system sites

P. Kim Streatfield, Wasif A. Khan, Abbas Bhuiya, Syed M.A. Hanifi, Nurul Alam, Ourohiré Millogo, Ali Sié, Pascal Zabré, Clementine Rossier, Abdramane B. Soura, Bassirou Bonfoh, Siaka Kone, Eliezer K. Ngoran, Juerg Utzinger, Semaw F. Abera, Yohannes A. Melaku, Berhe Weldearegawi, Pierre Gomez, Momodou Jasseh, Patrick AnsahDaniel Azongo, Felix Kondayire, Abraham Oduro, Alberta Amu, Margaret Gyapong, Odette Kwarteng, Shashi Kant, Chandrakant S. Pandav, Sanjay K. Rai, Sanjay Juvekar, Veena Muralidharan, Abdul Wahab, Siswanto Wilopo, Evasius Bauni, George Mochamah, Carolyne Ndila, Thomas N. Williams, Sammy Khagayi, Kayla F. Laserson, Amek Nyaguara, Anna M. Van Eijk, Alex Ezeh, Catherine Kyobutungi, Marylene Wamukoya, Menard Chihana, Amelia Crampin, Alison Price, Valérie Delaunay, Aldiouma Diallo, Laetitia Douillot, Cheikh Sokhna, F. Xavier Gómez-Olivé, Paul Mee, Stephen M. Tollman, Kobus Herbst, Joël Mossong, Nguyen T.K. Chuc, Samuelina S. Arthur, Osman A. Sankoh, Peter Byass

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Abstract

Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. Objective: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Design: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. Results: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Conclusions: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.

Original languageEnglish
Article number25370
JournalGlobal Health Action
Volume7
Issue number1
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

Bibliographical note

© 2014 INDEPTH Network
This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Keywords

  • Africa
  • Asia
  • HIV/AIDS
  • INDEPTH Network
  • InterVA
  • Mortality
  • Tuberculosis
  • Verbal autopsy

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