Burial surveillance detected significant reduction in HIV--related deaths in Addis Ababa, Ethiopia.

OBJECTIVE

To determine the level of HIV-related mortality reduction after the introduction of large-scale antiretroviral therapy (ART) using a burial surveillance system coupled with verbal autopsy (VA) in Addis Ababa, Ethiopia.

METHODS

Prospective burial surveillance was established in 2001 at cemeteries in Addis Ababa. VA interviews were periodically conducted on a random sample of adult burials registered between 2001 and 2009. Independent physicians reviewed the completed VA questionnaires and assigned underlying causes of death. The period before 2005 was defined as pre-ART and that since 2005 as the ART era. HIV-specific mortality fractions were calculated by age, sex and year of burial to examine the mortality trends before and during the ART era.

RESULTS

Of the 4239 VA physician diagnoses, 1087 (25.6%) were ascribed to HIV-related deaths. HIV-related deaths in 2009 were 33% fewer than in 2001. The proportion of HIV-related deaths was reduced from 44.0% in the pre-ART period to 20.0% in the ART era. Mortality in women (36.7%) declined more than in men (30%). A marked reduction in HIV-specific mortality was observed in the age group 30-39 years (from 69.1% pre-ART to 46.8% during ART era) compared to 20-29 (from 60.5% pre-ART to 41.0% during ART) and 40-49 year olds (49.7%) pre-ART to 34.4% during ART provision).

CONCLUSION

Burial surveillance combined with VA demonstrated a significant reduction in HIV-related deaths during the provision of free ART. Replication of burial surveillance is recommended in similar settings, where a vital registration system is non-existent, to track large-scale population-level interventions.