Programme Supplement [International Conference on AIDS (16th: 2006: Toronto, Canada)]

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Late Breaker Abstracts
minimum standard of quality (e.g. % of districts with specified ART
services); Coverage - the proportion of the population who receive
an intervention among those who need it (e.g. % of districts with at
least 80% of pregnant women receiving PMTCT services); Impact
- reduced new infection rates and survival improvements (such as
the UNGASS goals). implementation.The first two components are
directly related to programme implementation.
Lessons learned: Monitoring the ART scale-up (,,3 by 5")
showed the importance of international accountability and regular
monitoring of progress in the health sector; the need for systematic
investment in data collection and analysis; the challenge of global
targets and their country-specific adaptation; the need for special
efforts to monitor equity; and the importance of a direct link
between global goals and local programme management.
Recommendations: WHO will have to take responsibility for
monitoring progress in the health sector at the international level
and for guidance to countries, in close collaboration with partners,
and within the overall framework of the joint UN programme on
HIV/AIDS, building upon the lessons learned from,,3 by 5". The first
annual progress in the health report will be produced for 2006.
THLB0507
Declines in adult HIV mortality in Botswana, 2003-2005:
evidence for an impact of antiretroviral therapy programs
R. Stoneburner1, D. Montagu2, C. Pervilhac3, B. Fidzani4, W. Gill5,
G. Kennedy2, H. Spindler2, G. Rutherford2. 1University of California,
San Franciso, Institute for Global Health, San Francisco, United
States, 2University of California, San Francisco, Institute for Global
Health, San Francisco, United States, 3World Health Organization,
HIV/AIDS, Geneva, Switzerland, 4Botswana National AIDS
Coordinating Agency, Gaborone, Botswana, SUNAIDS, Botswana,
Gaborone, Botswana
Background: Antiretroviral therapies (ART) reverse
immunodeficiency and mortality among patients with severe HIVrelated disease; however, impacts of ART programs in reducing
HIV mortality at the population level in Sub-Saharan Africa have
yet to be documented. Such evidence is of strategic importance in
monitoring and evaluating intervention impacts.
Methods: We examined Botswana Ministry of Health mortality
statistics from 1991 through June 2005, and ART programmatic
data since 2002 on numbers of persons receiving therapy. Trends
over time in reported deaths by age, district and institutional
setting were examined to assess the overall impact of HIV, and
recent changes associated with the temporal and geographic
patterns of 54,378 adults receiving ART between 2003-5. Trends
in reported deaths were independently corroborated through an
ongoing nightly census of hospital admissions, discharges and
deaths.
Results: Concurrent with increasing HIV prevalence rates between
1991 and 2003, mortality rates among 25-54 year olds increased
four- fold, AIDS became the leading cause of institutional deaths in
1996, and the proportion of deaths from non-institutional settings
or external causes decreased. Trends in institutional deaths
stabilized in 2000 and then decreased 8% and 20% between 2003 -2004 and 2004-2005 respectively, co-incident with increasing ART
coverage. Mortality declined 27% and 17%, respectively, in the
Gaborone and Francistown districts with early ART initiation and
the highest ART coverage rates. District level mortality declines
were greatest among 20-54 year olds and significantly correlated
with both the initiation date and coverage rate (p<.05) of district
ART programs.
Conclusions: Our analysis provides evidence of an early association
between ART uptake and declines in adult mortality from 2003 to
2004-5. Alternative explanations including HIV natural dynamics or
biases in mortality reporting are less plausible. These preliminary
findings suggest that ART is reducing the impact of premature HIV
mortality in Botswana.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * PROGRAMME SUPPLEMENT