The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.

<h4>Background</h4>HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends...

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Autores principales:	Megan S C Lim, Robert J Dowdeswell, Jill Murray, Nigel Field, Judith R Glynn, Pam Sonnenberg
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2db46a12411441b7a22dca696720d67d
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spelling	oai:doaj.org-article:2db46a12411441b7a22dca696720d67d2021-11-18T07:14:34ZThe impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.1932-620310.1371/journal.pone.0038598https://doaj.org/article/2db46a12411441b7a22dca696720d67d2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22761688/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends in mortality and causes of death among South African platinum miners, from before the HIV epidemic into the ART era.<h4>Methodology/principal findings</h4>Retrospective analysis was conducted using routinely-collected data from an open cohort. Mortality and causes of death were determined from multiple sources, including cardiorespiratory autopsy records. All-cause and cause-specific mortality rates were calculated by calendar year. 41,665 male miners were observed for 311,938 person years (py) with 3863 deaths. The all-cause age-standardised mortality rate increased from 5.9/1000 py in 1992 to 20.2/1000 py in 2002. Following ART rollout in 2003, annual mortality rates fluctuated between 12.4/1000 py and 19.3/1000 py in the subsequent 7 years. Half of all deaths were HIV-related and 21% were caused by TB. Half (50%) of miners who died of HIV after ART rollout had never been registered on the Wellness programme. TB was the most common cause of death in HIV positive miners, increasing from 28% of deaths in the pre-ART period to 41% in the post-ART period.<h4>Conclusions/significance</h4>This population-based cohort experienced a rapid increase in mortality from 1996 to 2003 due to increases in HIV and TB mortality. Following ART rollout there was a decrease in mortality, but a steady decrease has not been sustained. Possible explanations for these trends include the changing composition of the workforce, maturation of the HIV epidemic, insufficient uptake of ART and an increase in the proportion of deaths due to TB. In order to make a significant and sustained reduction in mortality in this population, expanding and integrating HIV and TB care and treatment is essential.Megan S C LimRobert J DowdeswellJill MurrayNigel FieldJudith R GlynnPam SonnenbergPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 6, p e38598 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Megan S C Lim Robert J Dowdeswell Jill Murray Nigel Field Judith R Glynn Pam Sonnenberg The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
description	<h4>Background</h4>HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends in mortality and causes of death among South African platinum miners, from before the HIV epidemic into the ART era.<h4>Methodology/principal findings</h4>Retrospective analysis was conducted using routinely-collected data from an open cohort. Mortality and causes of death were determined from multiple sources, including cardiorespiratory autopsy records. All-cause and cause-specific mortality rates were calculated by calendar year. 41,665 male miners were observed for 311,938 person years (py) with 3863 deaths. The all-cause age-standardised mortality rate increased from 5.9/1000 py in 1992 to 20.2/1000 py in 2002. Following ART rollout in 2003, annual mortality rates fluctuated between 12.4/1000 py and 19.3/1000 py in the subsequent 7 years. Half of all deaths were HIV-related and 21% were caused by TB. Half (50%) of miners who died of HIV after ART rollout had never been registered on the Wellness programme. TB was the most common cause of death in HIV positive miners, increasing from 28% of deaths in the pre-ART period to 41% in the post-ART period.<h4>Conclusions/significance</h4>This population-based cohort experienced a rapid increase in mortality from 1996 to 2003 due to increases in HIV and TB mortality. Following ART rollout there was a decrease in mortality, but a steady decrease has not been sustained. Possible explanations for these trends include the changing composition of the workforce, maturation of the HIV epidemic, insufficient uptake of ART and an increase in the proportion of deaths due to TB. In order to make a significant and sustained reduction in mortality in this population, expanding and integrating HIV and TB care and treatment is essential.
format	article
author	Megan S C Lim Robert J Dowdeswell Jill Murray Nigel Field Judith R Glynn Pam Sonnenberg
author_facet	Megan S C Lim Robert J Dowdeswell Jill Murray Nigel Field Judith R Glynn Pam Sonnenberg
author_sort	Megan S C Lim
title	The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
title_short	The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
title_full	The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
title_fullStr	The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
title_full_unstemmed	The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.
title_sort	impact of hiv, an antiretroviral programme and tuberculosis on mortality in south african platinum miners, 1992-2010.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/2db46a12411441b7a22dca696720d67d
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The impact of HIV, an antiretroviral programme and tuberculosis on mortality in South African platinum miners, 1992-2010.

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