Tracking trends in HIV/AIDS mortality pre- & post ART: South Africa 1997-2012 Pillay-van Wyk V1, Bradshaw D1, Msemburi W1, Dorrington RE2, Laubscher R3, Groenewald P1 1Burden of Disease Research Unit, South African Medical Research Council, Cape Town 2Centre for Actuarial Research, University of Cape Town 3Biostatistics Unit, South African Medical Research Council, Cape Town Good afternoon, today I am going to share with you HIV/AIDS mortality trends or South Africa pre and post the antiretroviral treatment roll out using data from the second national burden of disease study.

BACKGROUND & METHODS South Africa extensive anti-retroviral (ART) rollout in sub-Saharan Africa ART programme began in 2005 Trends in HIV/AIDS mortality pre-&-post ART rollout 2nd South African National Burden of Disease study Vital registration data adjusted for mis-attributed HIV/AIDS deaths other data deficiencies South Africa has one of the most extensive ART programs in Sub Saharan Africa and this program was rolled out in 2005. Our country has a vital registration system that routinely collects cause of death information. However due to the stigma around HIV/AIDS in the country doctors don’t certify HIV/AIDS as a cause of death but rather attribute the death to AIDS indicator causes like TB, Diarrhoeas, Pneumonia – we identified 19 such causes – and removed the HIV/AIDS death from them and reallocated these deaths to HIV/AIDS. We also adjusted for other data deficiencies.

METHODS: Estimated HIV/AIDS deaths by reported cause of death and age, 1997- 2012 (N=~3,189,000 deaths) So after adjusting for misclassified HIV/AIDS deaths we found over 3 million deaths for the study period. This graph shows the number of AIDS deaths by age group that was reported to an AIDS indicator cause. Note the brown line at the bottom refers to the number of reported HIV/AIDS deaths in the vital registration data. The bars above represent the AIDS deaths that were re-attributed to HIV/AIDS and the AID indicator conditions they were taken from for example TB – the dark blue bar and diarrhea the dark green bar

RESULTS HIV/AIDS was the leading cause of death Number of HIV/AIDS deaths in 1997: 60 336 (14.5%) 2006: 283 564 (41.9%) 2012: 153 661 (29.1%) HIV/AIDS mortality rates peaked for females in 2005 and males in 2006 HIV/AIDS was the leading cause of death through out the study period accounting of 14% of totals in 1997, 41% by 2006 and 29% by 2012. HIV/AIDS Mortality peaked in 2006 for males and 2005 for women. 2nd SOUTH AFRICAN NATIONAL BURDEN OF DISEASE STUDY

RESULTS: HIV/AIDS death rates by sex & age group for 1997, 2000, 2006 & 2012 This graph reports the HIV/AIDS deaths rates for males on the left and females on the right by age group. In the 25-34 years age group, females had higher death rates than males. This pattern was reversed in the 45 years and older with males having higher rates. Males death rates among the 65 years and older age group was at the same level in 2012 as 2006, while death rates for males in the other ages declined after 2006. This shows little difference in mortality rates by age group for males over the age of 45 years. Female mortality rates had reached similar levels as 2000 by 2012.

CONCLUSION HIV/AIDS is the leading cause of death even though the number of HIV/AIDS deaths have almost halved since the ART roll out High HIV/AIDS mortality rates in males older than 45 years old by 2012 Treatment and prevention programmes should strategies how to target this risk group In conclusion, the number of deaths from HIV/AIDS have almost halved since the ART rollout showing that we have made gains in the fight against the HIV/AIDS epidemic in South Africa. However HIV/AIDS is still the leading cause of death in South. And males older than 45 years of age still have high mortality rates and have been identified as a risk group. Therefore we recommend that treatment and prevention programmes include in their stragetises how to target this risk group.

SOUTH AFRICAN BURDEN OF DISEASE TEAM Medical Research Council Dr Victoria Pillay-van Wyk Dr Debbie Bradshaw Mr William Msemburi Ms Ria Laubscher Dr Pam Groenewald Dr Richard Matzopolous Ms Megan Prinsloo Ms Beatrice Nojilana Dr Nadine Nannan Ms Nomonde Gwebushe Ms Ntuthu Somdyala Ms Nomfuneko Sithole Medical Research Council (cont) Mr Ian Neethling Dr Edward Nicol Dr Anastasia Rossouw Dr Jané Joubert University of Cape Town Prof Rob Dorrington Institute of Health Metrics Evaluation Prof Theo Vos FUNDERS