Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana.
<h4>Introduction</h4>Botswana's AIDS response included free antiretroviral treatment (ART) since 2002, achieving 80% coverage of persons with CD4<350 cells/µl by 2009-10. We explored impact on mortality and HIV prevalence, analyzing surveillance and civil registration data.<h4...
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2014-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0100431 |
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| author | Rand Stoneburner Eline Korenromp Mark Lazenby Jean-Michel Tassie Judith Letebele Diemo Motlapele Reuben Granich Ties Boerma Daniel Low-Beer |
| author_facet | Rand Stoneburner Eline Korenromp Mark Lazenby Jean-Michel Tassie Judith Letebele Diemo Motlapele Reuben Granich Ties Boerma Daniel Low-Beer |
| author_sort | Rand Stoneburner |
| collection | DOAJ |
| description | <h4>Introduction</h4>Botswana's AIDS response included free antiretroviral treatment (ART) since 2002, achieving 80% coverage of persons with CD4<350 cells/µl by 2009-10. We explored impact on mortality and HIV prevalence, analyzing surveillance and civil registration data.<h4>Methods</h4>Hospital natural cause admissions and deaths from the Health Statistics Unit (HSU) over 1990-2009, all-cause deaths from Midnight Bed Census (MNC) over 1990-2011, institutional and non-institutional deaths recorded in the Registry of Birth and Deaths (RBD) over 2003-2010, and antenatal sentinel surveillance (ANC) over 1992-2011 were compared to numbers of persons receiving ART. Mortality was adjusted for differential coverage and completeness of institutional and non-institutional deaths, and compared to WHO and UNAIDS Spectrum projections.<h4>Results</h4>HSU deaths per 1000 admissions declined 49% in adults 15-64 years over 2003-2009. RBD mortality declined 44% (807 to 452/100,000 population in adults 15-64 years) over 2003-2010, similarly in males and females. Generally, death rates were higher in males; declines were greater and earlier in younger adults, and in females. In contrast, death rates in adults 65+, particularly females increased over 2003-2006. MNC all-age post-neonatal mortality declined 46% and 63% in primary and secondary level hospitals, over 2003-2011. We estimated RBD captured 80% of adult deaths over 2006-2011. Comparing empirical, completeness-adjusted deaths to Spectrum estimates, declines over 2003-2009 were similar overall (47% vs. 54%); however, Spectrum projected larger and earlier declines particularly in women. Following stabilization and modest decreases over 1998-2002, HIV prevalence in pregnant women 15-24 and 25-29-years declined by >50% and >30% through 2011, while continuing to increase in older women.<h4>Conclusions</h4>Adult mortality in Botswana fell markedly as ART coverage increased. HIV prevalence declines may reflect ART-associated reductions in sexual transmission. Triangulation of surveillance system data offers a reasonable approach to evaluate impact of HIV/AIDS interventions, complementing cohort approaches that monitor individual-level health outcomes. |
| format | Article |
| id | doaj-art-eb1d7fb074d14b6cb11cf9787c8828aa |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
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| spelling | doaj-art-eb1d7fb074d14b6cb11cf9787c8828aa2025-08-20T03:10:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0197e10043110.1371/journal.pone.0100431Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana.Rand StoneburnerEline KorenrompMark LazenbyJean-Michel TassieJudith LetebeleDiemo MotlapeleReuben GranichTies BoermaDaniel Low-Beer<h4>Introduction</h4>Botswana's AIDS response included free antiretroviral treatment (ART) since 2002, achieving 80% coverage of persons with CD4<350 cells/µl by 2009-10. We explored impact on mortality and HIV prevalence, analyzing surveillance and civil registration data.<h4>Methods</h4>Hospital natural cause admissions and deaths from the Health Statistics Unit (HSU) over 1990-2009, all-cause deaths from Midnight Bed Census (MNC) over 1990-2011, institutional and non-institutional deaths recorded in the Registry of Birth and Deaths (RBD) over 2003-2010, and antenatal sentinel surveillance (ANC) over 1992-2011 were compared to numbers of persons receiving ART. Mortality was adjusted for differential coverage and completeness of institutional and non-institutional deaths, and compared to WHO and UNAIDS Spectrum projections.<h4>Results</h4>HSU deaths per 1000 admissions declined 49% in adults 15-64 years over 2003-2009. RBD mortality declined 44% (807 to 452/100,000 population in adults 15-64 years) over 2003-2010, similarly in males and females. Generally, death rates were higher in males; declines were greater and earlier in younger adults, and in females. In contrast, death rates in adults 65+, particularly females increased over 2003-2006. MNC all-age post-neonatal mortality declined 46% and 63% in primary and secondary level hospitals, over 2003-2011. We estimated RBD captured 80% of adult deaths over 2006-2011. Comparing empirical, completeness-adjusted deaths to Spectrum estimates, declines over 2003-2009 were similar overall (47% vs. 54%); however, Spectrum projected larger and earlier declines particularly in women. Following stabilization and modest decreases over 1998-2002, HIV prevalence in pregnant women 15-24 and 25-29-years declined by >50% and >30% through 2011, while continuing to increase in older women.<h4>Conclusions</h4>Adult mortality in Botswana fell markedly as ART coverage increased. HIV prevalence declines may reflect ART-associated reductions in sexual transmission. Triangulation of surveillance system data offers a reasonable approach to evaluate impact of HIV/AIDS interventions, complementing cohort approaches that monitor individual-level health outcomes.https://doi.org/10.1371/journal.pone.0100431 |
| spellingShingle | Rand Stoneburner Eline Korenromp Mark Lazenby Jean-Michel Tassie Judith Letebele Diemo Motlapele Reuben Granich Ties Boerma Daniel Low-Beer Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. PLoS ONE |
| title | Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. |
| title_full | Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. |
| title_fullStr | Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. |
| title_full_unstemmed | Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. |
| title_short | Using health surveillance systems data to assess the impact of AIDS and antiretroviral treatment on adult morbidity and mortality in Botswana. |
| title_sort | using health surveillance systems data to assess the impact of aids and antiretroviral treatment on adult morbidity and mortality in botswana |
| url | https://doi.org/10.1371/journal.pone.0100431 |
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