Volume 36 - Article 37 | Pages 1081–1108 
The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi
| Date received: | 10 Nov 2016 |
| Date published: | 05 Apr 2017 |
| Word count: | 2569 |
| Keywords: | antiretroviral therapy, HIV/AIDS, life expectancy, Malawi, population health |
| DOI: | 10.4054/DemRes.2017.36.37 |
Abstract
Background: Recent evidence from health and demographic surveillance sites (HDSS) has shown that increasing access to antiretroviral therapy (ART) is reducing mortality rates in sub-Saharan Africa (SSA). However, due to limited vital statistics registration in many of the countries most affected by the HIV/AIDS epidemic, there is limited evidence of the magnitude of ART’s effect outside of specific HDSS sites. This paper leverages longitudinal household/family roster data from the Malawi Longitudinal Survey of Families and Health (MLSFH) to estimate the effect of ART availability in public clinics on population-level mortality based on a geographically dispersed sample of individuals in rural Malawi.
Objective: We seek to provide evidence on the population-level magnitude of the ART-associated mortality decline in rural Malawi and confirm that this population is experiencing similar declines in mortality as those seen in HDSS sites.
Methods: We analyze longitudinal household/family-roster data from four waves of the MLSFH to estimate mortality change after the introduction of ART to study areas. We analyze life expectancy using the Kaplan–Meier estimator and examine how the mortality hazard changed over time by individual characteristics with Cox regression.
Results: In the four years following rollout of ART, life expectancy at age 15 increased by 3.1 years (95% CI 1.1, 5.1), and median length of life rose by over ten years.
Contribution: Our observations show that the increased availability of ART resulted in a substantial and sustained reversal of mortality trends in SSA and assuage concerns that the post-ART reversals in mortality are not occurring at the same magnitude outside of specific HDSSs.
Author's Affiliation
Collin Payne - Australian National University, Australia
Hans-Peter Kohler - University of Pennsylvania, United States of America
Other articles by the same author/authors in Demographic Research
»
The role of reductions in old-age mortality in old-age population growth
Volume 44 - Article 44
»
Marital dissolutions and changes in mental health: Evidence from rural Malawi
Volume 44 - Article 41
»
Intergenerational Transfers in the Era of HIV/AIDS: Evidence from Rural Malawi
Volume 27 - Article 27
»
The differential impact of mortality of American troops in the Iraq War: The non-metropolitan dimension
Volume 23 - Article 2
»
The Likoma Network Study: Context, data collection and initial results
Volume 21 - Article 15
»
Subjective expectations in the context of HIV/AIDS in Malawi
Volume 20 - Article 31
»
The Malawi Diffusion and Ideational Change Project 2004-06: Data collection, data quality, and analysis of attrition
Volume 20 - Article 21
»
Overestimating HIV infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi
Volume 20 - Article 6
»
A summary of Special Collection 1: Social Interactions and HIV/AIDS in Rural Africa
Volume 9 - Article 12
»
The Fertility Pattern of Twins and the General Population Compared: Evidence from Danish Cohorts 1945-64
Volume 6 - Article 14
»
Tempo-Adjusted Period Parity Progression Measures: Assessing the Implications of Delayed Childbearing for Cohort Fertility in Sweden, the Netherlands and Spain
Volume 6 - Article 7
»
Tempo-Adjusted Period Parity Progression Measures, Fertility Postponement and Completed Cohort Fertility
Volume 6 - Article 6
»
Attrition in Longitudinal Household Survey Data: Some Tests for Three Developing-Country Samples
Volume 5 - Article 4
»
Frailty Modelling for Adult and Old Age Mortality: The Application of a Modified DeMoivre Hazard Function to Sex Differentials in Mortality
Volume 3 - Article 8
»
Empirical Assessments of Social Networks, Fertility and Family Planning Programs: Nonlinearities and their Implications
Volume 3 - Article 7
»
Gender Preferences for Children in Europe: Empirical Results from 17 FFS Countries
Volume 2 - Article 1
»
Introduction to "Research on Demographic Aspects of HIV/AIDS in Rural Africa"
Special Collection 1 - Article 1
»
Talking about AIDS: The influence of communication networks on individual risk perceptions of HIV/AIDS infection and favored protective behaviors in South Nyanza District, Kenya
Special Collection 1 - Article 13
Most recent similar articles in Demographic Research
»
To what extent were life expectancy gains in South Africa attributable to declines in HIV/AIDS mortality from 2006 to 2017? A life table analysis of age-specific mortality
Volume 46 - Article 18 | Keywords: antiretroviral therapy, HIV/AIDS, life expectancy
»
Bayesian projection of life expectancy accounting for the HIV/AIDS epidemic
Volume 37 - Article 48 | Keywords: antiretroviral therapy, HIV/AIDS
»
Macroeconomic conditions and population health in Iceland
Volume 37 - Article 25 | Keywords: life expectancy, population health
»
Physical attractiveness and women’s HIV risk in rural Malawi
Volume 37 - Article 10 | Keywords: HIV/AIDS, Malawi
»
The age pattern of increases in mortality affected by HIV: Bayesian fit of the Heligman-Pollard Model to data from the Agincourt HDSS field site in rural northeast South Africa
Volume 29 - Article 39 | Keywords: HIV/AIDS, life expectancy
Articles
Citations
Cited References: 28
»View the references of this article
Download to Citation Manager
Similar Articles
PubMed
»Articles by Hans-Peter Kohler
Google Scholar
»Articles by Hans-Peter Kohler