Free Antiretroviral Therapy Cuts Mortality in Malawi
NEW YORK (Reuters Health) May 08 - Since free antiretroviral therapy was offered to more than 80,000 HIV-infected adults in Malawi a few years ago, mortality has fallen by up to 35%, according to a report in the May 10th issue of The Lancet.
Further analysis showed that mortality fell in patients 15 to 59 years of age, but not in those older than 60 years. This 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,” Dr. Andreas Jahn, from the London School of Hygiene and Tropical Medicine, and colleagues conclude.
Using a demographic surveillance system, the researchers examined mortality in a northern Malawian town of 32,000 before August 2002, when there was no antiretroviral therapy, until about 8 months after free antiretroviral therapy was available, in February 2006.
Prior to provision of antiretroviral therapy in June 2005, mortality among 15- to 59-year-olds was 9.8 deaths per 1000 person-years. Men and women were both 43% likely to die before reaching 60 years of age. Roughly two thirds of deaths were attributed to AIDS.
By February 2006, the authors estimate that 107 of 334 adults needing antiretroviral therapy had received it.
The availability of antiretroviral therapy was associated with a drop in overall adult mortality of 10% from 10.2 to 8.7 deaths per 1000 person-years. For adults living near the main road in the study town, however, the reduction was more marked: 35% from 13.2 to 8.5 deaths per 1000 person-years.
“Implementation of antiretroviral therapy across Malawi continues to accelerate, including a new public clinic in the surveillance area since September 2006. With continuing decentralization and increased access, population mortality rates should continue to fall,” the investigators believe.
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