After South Africa rolled out large-scale antiretroviral therapy (ART) programs for people with HIV infection during the early 2000s, life expectancy in 1 rural community increased sharply and treatment was proven cost-effective, according to new research in today’s Science.
Researchers from the Harvard School of Public Health in Boston analyzed data in household surveillance surveys collected between 2000 and 2011 in a district of KwaZulu-Natal that is one of the poorest in South Africa. Some 29% of adults in the community have HIV infection, and more than half of all deaths there were HIV-related a decade ago.
In 2004, however, South Africa launched public ART programs with the goal of treating everyone who met certain disease-stage criteria. The first patients in KwaZulu-Natal were enrolled in September of that year. By July 2011, 13.8% of community residents aged 15 years or older sought care in the program and 7.4% in that age group started ART.
Using surveillance data from the Africa Centre for Health and Population Studies, which included 101 286 residents at least 15 years old, the investigators tracked death dates to assess the community’s survival patterns before and after ART became available. Their analysis showed that adult life expectancy was 49.2 years in 2003; by 2011 it increased to 60.5 years—an 11.3-year gain. Men gained 9 years and women gained 13.3 years.
“This is one of the most rapid life expectancy gains observed in the history of public health,” senior author Till Bärnighausen, MD, ScD, said in a statement. Bärnighausen and his colleagues reported that mortality rates from injuries, noncommunicable diseases, and other causes remained stable during the study period.
Their cost-effectiveness analysis showed that $1593, which is one-fourth of South Africa’s 2011 per capita gross national income (GNI), would have to be invested in ART to save 1 year of life. Treatments that cost less than GNI are considered highly cost-effective, Bärnighausen said.
“We find that a real-life, public sector ART program in rural Africa is a very worthwhile investment,” he noted. “This information is important for governments and donors debating future investments for ART programs.”