Population-Level Reduction in Adult Mortality after Extension of Free Anti-Retroviral Therapy Provision into Rural Areas in Northern Malawi 英文参考文献.docVIP

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Population-Level Reduction in Adult Mortality after Extension of Free Anti-Retroviral Therapy Provision into Rural Areas in Northern Malawi 英文参考文献.doc

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Population-Level Reduction in Adult Mortality after Extension of Free Anti-Retroviral Therapy Provision into Rural Areas in Northern Malawi 英文参考文献

Population-LevelReductioninAdultMortalityafter ExtensionofFreeAnti-RetroviralTherapyProvisioninto RuralAreasinNorthernMalawi SianFloyd1*,AnnaMolesworth1,2,AlbertDube2,EmmanuelBanda2,AndreasJahn1 ,Charles Mwafulirwa2,BagreyNgwira1,2,KeithBranson1,AmeliaC.Crampin1,2,BasiaZaba1,JudithR.Glynn1 ,Neil French1,2 1DepartmentofInfectiousDiseaseEpidemiology,LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom,2KarongaPreventionStudy,Chilumba, Karonga,Malawi Abstract Background: Four studies from sub-Saharan Africa have found a substantial population-level effect of ART provision on adultmortality.Itisimportanttoseeiftheimpactchangeswithtimesincethestartoftreatmentscale-up,andastreatment movestosmallerclinics. MethodsandFindings:During2002-4ademographicsurveillancesite(DSS)wasestablishedinKarongadistrict,northern Malawi.Informationonbirthsanddeathsiscollectedmonthly,withverbalautopsiesconductedforalldeaths;migrations areupdatedannually.Weanalysedmortalitytrendsbycomparingthreetimeperiods:pre-ARTroll-outinthedistrict(August 2002–June2005),ARTperiod1(July2005–September2006)whenARTwasavailableonlyinatown70kmaway,andART period2(October2006–September2008),whenARTwasavailableataclinicwithintheDSSarea.HIVprevalenceandART uptakewereestimatedfromasero-surveyconductedin2007/2008.Theall-causemortalityrateamong15–59yearoldswas 10.2per1000person-yearsinthepre-ARTperiod(288deaths/28285person-years).Itfellby16%inARTperiod1andby 32%inARTperiod2(95%CI18%–43%),comparedwiththepre-ARTperiod.TheAIDSmortalityratefellfrom6.4to4.6to 2.7per1000person-yearsinthepre-ARTperiod,period1andperiod2respectively(rateratioforperiod2=0.43,95%CI 0.33–0.56).Therewaslittlechangeinnon-AIDSmortality.TreatmentcoverageamongindividualseligibletostartARTwas around70%in2008. Conclusions:ARTcanhaveadramaticeffectonmortalityinaresource-constrainedsettinginAfrica,atleastintheearly yearsoftreatmentprovision.OurfindingssupportthedecentraliseddeliveryofARTfromperipheralhealthcentreswith unsophisticatedfacilities.Cont