Volume 51 - Article 38 | Pages 1183–1200  

Excess mortality associated with HIV: Survey estimates from the PHIA project

By Shannon Farley, Giles Reid, Kay Yuengling, Connor Wright, Vesper H. Chisumpa, George Bello, James M. Juma, Abigail R. Greenleaf, Stephen McCracken, Paul Stupp, Stephane Helleringer, Jessica Justman

Abstract

Background: Incomplete vital statistics systems in resource-limited countries hinder accurate HIV epidemic assessments. Population-based survey data combined with HIV infection biomarkers may partially address this gap, providing excess mortality estimates in households where people living with HIV (PLWH) reside.

Objective: Examine household-level excess HIV mortality in households with PLWH using population-based survey data, including mortality reported by heads of households, and HIV biomarkers.

Methods: We compared mortality between households with and without PLWH using publicly available data from 11 Population-based HIV Impact Assessments conducted between 2015 and 2019 in Cameroon, Côte d’Ivoire, Eswatini, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Eligible, consenting household members provided blood for HIV testing. Household-level regression models estimated deaths per 1,000 person-years (PY) for the three-year period before the survey; death rate ratios were calculated. Quasi-Poisson distribution accounted for household death over-dispersion.

Results: Country-specific deaths rates per 1,000 PY were significantly higher among rural versus urban households for five countries. For example, in Cameroon, the rates were 9.3 (95% confidence interval [CI]: 8.7–9.9) versus 6.5 (95% CI: 5.9–7.1). In six countries, death rates were significantly higher (1.3–1.7-fold) among households with PLWH versus those without. Death rate ratios were significantly higher among rural (1.4–1.8-fold) and urban households (1.6–2.3-fold) with PLWH versus those without in four and three countries, respectively.

Conclusions: General population household survey findings in multiple countries in Africa indicate that households where PLWH resided experienced excess mortality relative to other households.

Contribution: The novel approach we use to describe HIV-related household-level mortality offers an additional method to measure progress toward zero AIDS-related deaths.

Author’s Affiliation

• Shannon Farley - Columbia University, United States of America EMAIL
• Giles Reid - Columbia University, United States of America EMAIL
• Kay Yuengling - Columbia University, United States of America EMAIL
• Connor Wright - Columbia University, United States of America EMAIL
• Vesper H. Chisumpa - University of Zambia, Zambia EMAIL
• George Bello - Ministry of Health, Malawi, Malawi EMAIL
• James M. Juma - Ministry of Health, Tanzania , Tanzania, United Republic Of EMAIL
• Abigail R. Greenleaf - Columbia University, United States of America EMAIL
• Stephen McCracken - Centers for Disease Control and Prevention, United States of America EMAIL
• Paul Stupp - Centers for Disease Control and Prevention, United States of America EMAIL
• Stephane Helleringer - New York University, Abu Dhabi, United Arab Emirates EMAIL
• Jessica Justman - Columbia University, United States of America EMAIL

Other articles by the same author/authors in Demographic Research

Interrogating the quality and completion of mortality mobile phone interviews conducted in Malawi during COVID-19: An examination of interviewer–respondent interactions
Volume 51 - Article 46

Improving old-age mortality estimation with parental survival histories in surveys
Volume 51 - Article 45

Knowledge, risk perceptions, and behaviors related to the COVID-19 pandemic in Malawi
Volume 44 - Article 20

Improving age measurement in low- and middle-income countries through computer vision: A test in Senegal
Volume 40 - Article 9

Estimating mortality from external causes using data from retrospective surveys: A validation study in Niakhar (Senegal)
Volume 38 - Article 32

The Likoma Network Study: Context, data collection and initial results
Volume 21 - Article 15

Most recent similar articles in Demographic Research

The use of mobile phone surveys for rapid mortality monitoring: A national study in Burkina Faso
Volume 52 - Article 16    | Keywords: age-specific mortality patterns, data quality, Demographic Health Surveys, direct estimation, health and security crises, low-and-middle-income countries, mobile phones, mortality, sample selection, surveys, under-five mortality

Interrogating the quality and completion of mortality mobile phone interviews conducted in Malawi during COVID-19: An examination of interviewer–respondent interactions
Volume 51 - Article 46    | Keywords: audio-recording, LMICs, Malawi, mobile phone survey, mortality, RaMMPS

A Bayesian model for age at death with cohort effects
Volume 51 - Article 33    | Keywords: age at death, Bayesian approach, cohort effects, Italy, mortality

The impact of the COVID-19 pandemic on mortality in Uruguay from 2020 to 2022
Volume 51 - Article 29    | Keywords: COVID-19, excess mortality, life expectancy, Uruguay

On the relationship between life expectancy, modal age at death, and the threshold age of the life table entropy
Volume 51 - Article 24    | Keywords: Gompertz law, life expectancy, lifespan variation, longevity, mode, mortality