CROI 2025 Abstract eBook

Abstract eBook

Oral Abstracts

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WITHDRAWN

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All-Cause and Cause-Specific Mortality Trends Among Persons With and Without HIV in Rural Tanzania Julie Ambia 1 , Clara Calvert 2 , Emma Slaymaker 3 , Mark Urassa 4 , Milly Marston 3 , Suzanne M. Ingle 1 , Adam Trickey 1 1 University of Bristol, Bristol, UK, 2 University of Edinburgh, Edinburgh, UK, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 National Institute for Medical Research, Kisesa HDSS, Mwanza, United Republic of Tanzania Background: Comparing cause-specific mortality among people with HIV (PWH) and people without HIV (PWOH) is important for tracking improved survival following increased antiretroviral therapy (ART) access. However, comprehensive data on cause-specific mortality rates in Sub-Saharan Africa remains inadequate. We estimated mortality trends in Tanzania. Methods: Data were collected in a health and demographic surveillance system (HDSS) in Magu, rural Tanzania from 1994-2023, among individuals aged ≥15 years. For people who died, a verbal autopsy was conducted and the InSilicoVA statistical algorithm was used to ascertain the main cause of death. The duration of residency within the HDSS was utilized to estimate follow-up time in this open cohort. People could leave and re-enter the HDSS in this analysis and follow-up ended at the earliest of death date, out-migration or administrative censoring. To calculate cause-specific mortality rates, follow-up was censored for the other causes of death. Causes of death were grouped as: HIV/AIDS/tuberculosis, infectious diseases, non-communicable diseases (NCD), external causes, direct obstetric-related deaths, and missing. Standardized mortality ratios (SMRs) were calculated from the indirect standardization method by dividing observed by expected deaths with PWOH being the standard population. Results: Among 99,380 adults contributing 425,004 person-years, median age at follow-up start was 27 years (interquartile range: 21-38) and 55% were women. During follow-up, 4,120 died, with 68% of deaths assigned a cause. Among PWH and those with unknown HIV status, crude all-cause mortality declined over the years, whilst for PWOH, crude mortality was relatively constant post-2000 (Figure). Compared to PWOH, overall mortality was 6 times higher among PWH. SMRs comparing PWH with PWOH for all-cause mortality decreased from 16.4 (95% confidence interval [CI]: 15.2-17.7) in 1994-1999 to 4.7 (95% CI: 4.1-5.3) in 2020-2023. The highest SMR, 109.2 (95% CI: 98.8-119.6), was of mortality due to HIV/AIDS/tuberculosis between 2015 and 2019. SMRs for mortality due to infectious diseases, external causes, and direct obstetrics declined in later years, while SMRs for mortality due to HIV/AIDS/tuberculosis and NCD increased. Conclusions: There is continuing elevated mortality among PWH, compared with PWOH, with HIV/AIDS/tuberculosis remaining the leading cause of death, highlighting the need to address barriers to HIV treatment to capitalize on the benefits of increased ART coverage.

Oral Abstracts

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CROI 2025