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      Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment.

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      Journal: Science (New York, N.Y.)
      Keywords: Adult, Anti-HIV Agents, economics, therapeutic use, Antiretroviral Therapy, Highly Active, Cohort Studies, Cost-Benefit Analysis, Delivery of Health Care, Female, HIV Infections, drug therapy, mortality, Humans, Kaplan-Meier Estimate, Life Expectancy, trends, Male, Middle Aged, Mortality, Prevalence, Public Sector, Rural Health, South Africa, epidemiology, Value of Life, Young Adult

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          Abstract

          The scale-up of antiretroviral therapy (ART) is expected to raise adult life expectancy in populations with high HIV prevalence. Using data from a population cohort of over 101,000 individuals in rural KwaZulu-Natal, South Africa, we measured changes in adult life expectancy for 2000-2011. In 2003, the year before ART became available in the public-sector health system, adult life expectancy was 49.2 years; by 2011, adult life expectancy had increased to 60.5 years--an 11.3-year gain. Based on standard monetary valuation of life, the survival benefits of ART far outweigh the costs of providing treatment in this community. These gains in adult life expectancy signify the social value of ART and have implications for the investment decisions of individuals, governments, and donors.

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          Most cited references39

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          Nonparametric Estimation from Incomplete Observations

          E. Kaplan, Paul Meier (1958)
          Article 0 comments Cited 1093 times – based on 0 reviews     Review now
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            The Statistical Analysis of Failure Time Data

            John Kalbfleisch, Ross L Prentice (2002)
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              High Coverage of ART Associated with Decline in Risk of HIV Acquisition in Rural KwaZulu-Natal, South Africa

              Frank Tanser, Till Bärnighausen, Erofili Grapsa … (2013)
              In the battle to control HIV, mass antiretroviral treatment (ART) costs $500 to $900 per person per year. Bor et al. (p. [Related article:] 961 ) calculated the impact of intensifying ART on the life expectancy of people living in rural KwaZulu Natal. The dates of death were collected from a population of about 100,000 people during 2000–2011: Four years before and 8 years after the scaling up of ART. Life expectancy of adults increased by more than 11 years after ART was expanded, and the economic value of the lifetimes gained were calculated to far exceed the cost of treatment. Tanser et al. (p. [Related article:] 966 ) followed nearly 17,000 HIV-uninfected individuals in KwaZulu-Natal over an 8-year period. Holding other HIV risk factors constant, individual HIV acquisition risk declined significantly with increasing ART coverage of HIV-infected people. The risk of acquiring HIV is reduced in rural communities via large-scale delivery of antiretroviral therapy. The landmark HIV Prevention Trials Network (HPTN) 052 trial in HIV-discordant couples demonstrated unequivocally that treatment with antiretroviral therapy (ART) substantially lowers the probability of HIV transmission to the HIV-uninfected partner. However, it has been vigorously debated whether substantial population-level reductions in the rate of new HIV infections could be achieved in "real-world" sub-Saharan African settings where stable, cohabiting couples are often not the norm and where considerable operational challenges exist to the successful and sustainable delivery of treatment and care to large numbers of patients. We used data from one of Africa's largest population-based prospective cohort studies (in rural KwaZulu-Natal, South Africa) to follow up a total of 16,667 individuals who were HIV-uninfected at baseline, observing individual HIV seroconversions over the period 2004 to 2011. Holding other key HIV risk factors constant, individual HIV acquisition risk declined significantly with increasing ART coverage in the surrounding local community. For example, an HIV-uninfected individual living in a community with high ART coverage (30 to 40% of all HIV-infected individuals on ART) was 38% less likely to acquire HIV than someone living in a community where ART coverage was low (<10% of all HIV-infected individuals on ART).
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                Author and article information

                Journal
                PubMed ID:: 23430655
                PMC ID:: 3860268
                DOI:: 10.1126/science.1230413

                ScienceOpen disciplines: Chemistry
                Keywords: Adult,Anti-HIV Agents,economics,therapeutic use,Antiretroviral Therapy, Highly Active,Cohort Studies,Cost-Benefit Analysis,Delivery of Health Care,Female,HIV Infections,drug therapy,mortality,Humans,Kaplan-Meier Estimate,Life Expectancy,trends,Male,Middle Aged,Mortality,Prevalence,Public Sector,Rural Health,South Africa,epidemiology,Value of Life,Young Adult
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                ScienceOpen disciplines: Chemistry
                Keywords: Adult, Anti-HIV Agents, economics, therapeutic use, Antiretroviral Therapy, Highly Active, Cohort Studies, Cost-Benefit Analysis, Delivery of Health Care, Female, HIV Infections, drug therapy, mortality, Humans, Kaplan-Meier Estimate, Life Expectancy, trends, Male, Middle Aged, Mortality, Prevalence, Public Sector, Rural Health, South Africa, epidemiology, Value of Life, Young Adult

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