Adult Life Expectancy in the Antiretroviral Treatment Era: Evidence from Four Population-Based HIV Surveillance Studies in Uganda, Malawi and South Africa.

Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Kathryn Risher, London School of Hygiene and Tropical Medicine
Jeff Eaton, Imperial College London

Few studies directly measure the population-wide impact of antiretroviral therapy (ART) on HIV related mortality in Africa. We describe (i) trends in adult life expectancy (LE) at age 15, (ii) the LE gains attributable to ART, and (iii) the remaining LE deficit due to HIV in four population-based HIV surveillance sites. We fit a model of age-specific HIV incidence and natural survival to estimate counterfactual LE trends in the absence of ART and use that to derive the gains attributable to ART. Estimates are disaggregated by sex and span the years 1985 to 2015. Total or gross LE gains range between 6 and 17 years and are larger for women than men. LE gains are largest in eastern Africa, where HIV prevalence declined prior to ART availability, but the net effect of ART is largest in South African sites, where LE would have continued to decline without ART.