Scale-up of HIV treatment in rural South Africa

The large antiretroviral treatment (ART) scale-up in a rural community in KwaZulu-Natal, South Africa, has led to a rapid and dramatic increase in population adult life expectancy, according to new research from Harvard School of Public Health (HSPH). While previous studies have shown that ART significantly improves survival in clinical cohorts of HIV patients receiving ART, this is the first study to directly measure the full population-level impact of a public-sector ART program on adult life expectancy. The researchers measured dates of death using data from a large community-based population surveillance system, which included information on all births and deaths among more than 100,000 people living in rural KwaZulu-Natal between 2000 and 2011. Data were collected twice a year, through household surveys, by the Africa Center for Health and Population Studies at the University of KwaZulu-Natal. In 2003, the year before ART became widely available to people in KwaZulu-Natal, adult life expectancy was 49.2 years; by 2011, it had increased to 60.5 years. Both men and women experienced large gains in life expectancy -- nine years and 13.3 years, respectively. Using cause of death data, the researchers calculated life expectancy among people dying of causes other than HIV. They found that the observed life expectancy gains were almost exclusively due to changes in HIV-related mortality, with no changes in mortality rates from other causes. "This is one of the most rapid life expectancy gains observed in the history of public health," said Till Barnighausen, associate professor of global health in the HSPH and senior author of the study, which was published online Thursday in journal Science.