Introduction of free antiretroviral therapy (ART) for HIV patients in Malawi has reduced adult mortality enough for the effect to be detectable at the population level, conclude authors of a study published in this week’s edition of The Lancet.
Malawi, which has about 80000 deaths from AIDS every year, made free ART available to more than 80000 patients between 2004 and 2006. Dr Andreas Jahn and Professor Judith Glynn, London School of Hygiene and Tropical Medicine (LSHTM), and colleagues from both LSHTM and the Karonga Prevention Study, Malawi, aimed to investigate HIV-related mortality in a population before and after the introduction of the free ART programme.
The researchers measured mortality in a population of 32000 in Northern Malawi, from August 2002 when free ART was not available in the study district, until February 2006, eight months after a free ART clinic opened.
The researchers found that before June 2005, mortality in adults aged 15-59 years was 9.8 per deaths 1000 person-years of observation. The probability of dying between these ages was 43% for men and 43% for women; 229 of 352 deaths (65%) were attributed to AIDS. Eight months after the free ART clinic opened, 107 adults from the study population had accessed treatment, of an estimated 334 in need of treatment. Overall mortality in adults fell by 10%, however mortality fell by 35% in adults near to the main road, where pre-ART mortality was highest. Mortality in adults aged 60 years or older did not change.
The authors conclude: “Our findings of a reduction in mortality in adults aged between 15 and 59 years, with no change in those older than 60 years, suggests that deaths from AIDS were averted by the rapid scale-up of free antiretroviral therapy in rural Malawi, which led to a decline in adult mortality that was detectable at the population level.”
In an accompanying Comment, Dr Matthias Egger and Dr Andrew Boulle, University of Cape Town, South Africa, emphasise the challenges of universal access to ART – pointing out that while people living close to the main road in the Malawi study had a big drop in mortality, some more remote areas saw mortality increase. They say: “Continued monitoring of the public-health effect of ART at the population level, including of such inequalities, is required as the scale-up of treatment in resource-limited settings continues.”
Dr Andreas Jahn, London School of Hygiene and Tropical Medicine, UK T) +265 9 387 418 E) andreas.jahn@lshtm.ac.uk
Professor Judith Glynn, London School of Hygiene and Tropical Medicine, UK T) +44(0)20 7927 2423 E) judith.glynn@lshtm.ac.uk
Dr Matthias Egger, University of Cape Town, South Africa and University of Bern, Switzerland T) +41 31 631 35 01 E) egger@ispm.unibe.ch
http://multimedia.thelancet.com/pdf/press/MalawiHIV.pdf
Journal
The Lancet