TY - JOUR TI - Sustained 10-year gain in adult life expectancy following antiretroviral therapy roll-out in rural Malawi: July 2005 to June 2014 AU - Price, A. J. AU - Glynn, J. AU - Chihana, M. AU - Kayuni, N. AU - Floyd, S. AU - Slaymaker, E. AU - Reniers, G. AU - Zaba, B. AU - McLean, E. AU - Kalobekamo, F. AU - Koole, O. AU - Nyirenda, M. AU - Crampin, A. C. T2 - Int J Epidemiol AB - Background: Improved life expectancy in high HIV prevalence populations has been observed since antiretroviral therapy (ART) scale-up. However, it is unclear if the benefits are sustained, and the mortality among HIV-positive individuals not (yet) on ART is not well described. We assessed temporal change in mortality over 9 years in rural Malawi. Methods: Within a demographic surveillance site in northern rural Malawi, we combined demographic, HIV and ART uptake data. We calculated life expectancy using Kaplan-Meier estimates, and compared mortality rates and rate ratios using Poisson regression, by period of ART availability (July 2005-June 2008, July 2008-June 2011 and July 2011-June 2014). Results: Among 32 664 individuals there were 1424 deaths; 1930 individuals were known HIV-positive, of whom 1382 started ART. Overall, life expectancy at age 15 years increased by 10 years within 5 years of ART introduction, and plateaued. Age-standardized adult mortality rates declined from 11.3/1000 to 7.5/1000 person-years between the first and last time period. In July 2011-June 2014 compared with July 2005-June 2008, mortality declined in HIV-positive individuals on ART (rate ratio adjusted (aRR) for age, sex, location and education, 0.3; 95% confidence interval (CI) 0.2-0.5) and in those not (yet) on ART (aRR 0.3; 95%CI 0.1-0.5) but not in HIV-negative individuals (aRR 1.1; 95%CI 0.7-1.9). Conclusions: Total population adult life expectancy increased toward that of HIV-negative individuals by 2011 and remained raised. The reduction in all-cause and HIV-related mortality in HIV-positive individuals not (yet) on ART suggests ART uptake is occurring at an earlier disease stage, particularly in women. DA - 2017/04/01/ PY - 2017 DO - 10.1093/ije/dyw208 VL - 46 IS - 2 SP - 479 EP - 491 SN - 1464-3685 (Electronic) 0300-5771 (Linking) UR - https://www.ncbi.nlm.nih.gov/pubmed/28338707 AN - 28338707 KW - *Antiretroviral Therapy, Highly Active KW - *HIV, ART, mortality, life-expectancy, Malawi, sub-Saharan Africa KW - Adolescent KW - Adult KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Female KW - Gates1 KW - HIV Infections/*drug therapy/*mortality KW - HIV mortality KW - Humans KW - Kaplan-Meier Estimate KW - Life Expectancy/*trends KW - Logistic Models KW - Malawi/epidemiology KW - Male KW - Middle Aged KW - Population Surveillance KW - Sex Distribution KW - Young Adult ER -