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Impact of HIV/AIDS and ART on mortality in South African platinum miners: 1992-2008

Impact of HIV/AIDS and ART on mortality in South African platinum miners: 1992-2008. Megan Lim, Robert Dowdeswell, Jill Murray, Judith Glynn, Nigel Field, & Pam Sonnenberg. Background. Mortality in sub-Saharan Africa has risen dramatically since the 1990s Most deaths are due to HIV/AIDS

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Impact of HIV/AIDS and ART on mortality in South African platinum miners: 1992-2008

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  1. Impact of HIV/AIDS and ART on mortality in South African platinum miners: 1992-2008 Megan Lim, Robert Dowdeswell, Jill Murray, Judith Glynn, Nigel Field, & Pam Sonnenberg

  2. Background • Mortality in sub-Saharan Africa has risen dramatically since the 1990s • Most deaths are due to HIV/AIDS • Implementation of ART should affect this • ART programmes show positive outcomes • What is the impact at population level?

  3. Setting • Platinum mine, North West Province • All employees receive free medical care • HIV programme includes prevention, VCT, Wellness programme and ART (since 2003) • HIV prevalence around 27% in 2002

  4. AIM • to examine the impact of HIV & ART on mortality trends in South African Platinum Miners1992 to 2008 • All-cause mortality • Cause-specific mortality • Trends: • baseline (1992-1994) • Pre ART (1995-March2003) • Post ART (April2003-2008)

  5. Methods • Retrospective data analysis from routine sources • Cause of death from autopsy, medical certificate & death registry • Cohort • All semi and unskilled male employees • Jan 1 1992 to Dec 31 2008 • Medically boarded patients followed for additional year

  6. Burden of Disease Groups • Communicable • Non-communicable • Violence and injuries • HIV-related

  7. Results • Study population 40,043 men • 280,918 person years of follow-up • 3277 deaths • Mortality rate 11.9 / 1000 person years Causes of mortality (Burden of Disease groups) n=3277

  8. Mortality by cause and year

  9. Mortality by cause and year

  10. ART Mortality by cause and year

  11. ART Mortality by cause and year

  12. Deaths from HIV in the ART era, programme and treatment status n=886

  13. Causes of Death (%)

  14. Causes of Death (%)

  15. Causes of Death (%)

  16. Causes of Death (%)

  17. TB mortality rate in population

  18. TB mortality rate in population IRR 16 (7-36)

  19. TB mortality rate in population IRR 3 (2-3)

  20. TB mortality rate in population IRR 41 (18-92)

  21. Discussion • Rapid increase in mortality from 1997 to 2003 • Decline in mortality after ART in 2003 • Increase in mortality from 2006 to 2008 • Large increase in TB • Over half who died from HIV never accessed Wellness programme • Never tested • Refused / unable to access programme

  22. LimitationsStrengths • Occupational setting • HIV status on living individuals unknown • Large cohort • Long time period • Population-based • Accurate cause of death ascertainment

  23. Conclusions • ART programmes are effective but population-based data are required to evaluate their wider community impact • Population based evaluations need longer follow-up time • Need to address barriers to accessing programme • Emphasis on ART roll-out should be coupled with integrated TB/HIV programmes

  24. Acknowledgements • Study funded by Colt Foundation, UK • Megan Lim funded by NH&MRC, Australian government • Thanks to; • Sr Poppy Ntehelang, Dr Lesego Rametsi, and Sr Connie Modise (Platinum Health) • Dr Lettie la Grange and Charles Mbekeni (Anglo Platinum) • Karen Keulder (PMR) • Josephine Molate, Kele Tlhaole, Dineo Sefanyetso, and Pavlo Matlakala (Colt Foundation) • Dr Craig Innes and Dr Victoria Johnstone (Aurum Institute) • Gill Nelson (NIOH) • Dr Andrew Copas (UCL)

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