Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana.

Autor: Stoneburner R; UNAIDS, Geneva, Switzerland., Korenromp E; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands., Lazenby M; Yale University School of Nursing, New Haven, Connecticut, United States of America., Tassie JM; World Health Organization, Geneva, Switzerland., Letebele J; Republic of Botswana Ministry of Health, Gaborone, Botswana., Motlapele D; Republic of Botswana Ministry of Health, Gaborone, Botswana., Granich R; UNAIDS, Geneva, Switzerland., Boerma T; World Health Organization, Geneva, Switzerland., Low-Beer D; Global Health Program, The Graduate Institute of International and Development Studies, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2014 Jul 08; Vol. 9 (7), pp. e100431. Date of Electronic Publication: 2014 Jul 08 (Print Publication: 2014).
DOI: 10.1371/journal.pone.0100431
Abstrakt: Introduction: Botswana's AIDS response included free antiretroviral treatment (ART) since 2002, achieving 80% coverage of persons with CD4<350 cells/µl by 2009-10. We explored impact on mortality and HIV prevalence, analyzing surveillance and civil registration data.
Methods: Hospital natural cause admissions and deaths from the Health Statistics Unit (HSU) over 1990-2009, all-cause deaths from Midnight Bed Census (MNC) over 1990-2011, institutional and non-institutional deaths recorded in the Registry of Birth and Deaths (RBD) over 2003-2010, and antenatal sentinel surveillance (ANC) over 1992-2011 were compared to numbers of persons receiving ART. Mortality was adjusted for differential coverage and completeness of institutional and non-institutional deaths, and compared to WHO and UNAIDS Spectrum projections.
Results: HSU deaths per 1000 admissions declined 49% in adults 15-64 years over 2003-2009. RBD mortality declined 44% (807 to 452/100,000 population in adults 15-64 years) over 2003-2010, similarly in males and females. Generally, death rates were higher in males; declines were greater and earlier in younger adults, and in females. In contrast, death rates in adults 65+, particularly females increased over 2003-2006. MNC all-age post-neonatal mortality declined 46% and 63% in primary and secondary level hospitals, over 2003-2011. We estimated RBD captured 80% of adult deaths over 2006-2011. Comparing empirical, completeness-adjusted deaths to Spectrum estimates, declines over 2003-2009 were similar overall (47% vs. 54%); however, Spectrum projected larger and earlier declines particularly in women. Following stabilization and modest decreases over 1998-2002, HIV prevalence in pregnant women 15-24 and 25-29-years declined by >50% and >30% through 2011, while continuing to increase in older women.
Conclusions: Adult mortality in Botswana fell markedly as ART coverage increased. HIV prevalence declines may reflect ART-associated reductions in sexual transmission. Triangulation of surveillance system data offers a reasonable approach to evaluate impact of HIV/AIDS interventions, complementing cohort approaches that monitor individual-level health outcomes.
Databáze: MEDLINE
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