Mortality along the continuum of HIV care in Rwanda: a model-based analysis

Abstract Background HIV is the leading cause of death among adults in sub-Saharan Africa. However, mortality along the HIV care continuum is poorly described. We combine demographic, epidemiologic, and health services data to estimate where are people with HIV dying along RwandaĆ¢ s care continuum. Methods We calibrated an age-structured HIV disease and transmission stochastic simulation model to the epidemic in Rwanda. We estimate mortality among HIV-infected individuals in the following states: untested, tested without establishing care in an antiretroviral therapy (ART) program (unlinked), in care before initiating ART (pre-ART), lost to follow-up (LTFU) following ART initiation, and retained in active ART care. We estimated mortality among people living with HIV in Rwanda through 2025 under current conditions, and with improvements to the HIV care continuum. Results In 2014, the greatest portion of deaths occurred among those untested (35.4%), followed by those on ART (34.1%), reflecting the large increase in the population on ART. Deaths among those LTFU made up 11.8% of all deaths among HIV-infected individuals in 2014, and in the base case this portion increased to 18.8% in 2025, while the contribution to mortality declined among those untested, unlinked, and in pre-ART. In our model only combined improvements to multiple aspects of the HIV care continuum were projected to reduce the total number of deaths among those with HIV, estimated at 8177 in 2014, rising to 10,659 in the base case, and declining to 5,691 with combined improvements in 2025. Conclusion Mortality among those untested for HIV contributes a declining portion of deaths among HIV-infected individuals in Rwanda, but the portion of deaths among those LTFU is expected to increase the most over the next decade. Combined improvements to the HIV care continuum might be needed to reduce the number of deaths among those with HIV.

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PID https://www.doi.org/10.6084/m9.figshare.c.3633308
PID https://www.doi.org/10.6084/m9.figshare.c.3633308.v1
URL https://dx.doi.org/10.6084/m9.figshare.c.3633308.v1
URL https://dx.doi.org/10.6084/m9.figshare.c.3633308
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Author Bendavid, Eran, 0000-0002-8364-4711
Author Stauffer, David
Author Remera, Eric
Author Nsanzimana, Sabin
Author Kanters, Steve
Author Mills, Edward
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Publication Date 2016-12-15
Publisher Figshare
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keyword FOS: Mathematics
keyword FOS: Health sciences
keyword FOS: Sociology
keyword FOS: Biological sciences
keyword FOS: Earth and related environmental sciences
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Source https://science-innovation-policy.openaire.eu/search/dataset?datasetId=dedup_wf_001::9dd1d08f59cfff91770112a38ff887da
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Last Updated 6 January 2021, 21:36 (CET)
Created 6 January 2021, 21:36 (CET)