HIV mortality and infection in India

HIV mortality and infection in India: estimates from nationally representative mortality survey of 1.1 million homes.

Jha P, Kumar R, Khera A, Bhattacharya M, Arora P, Gajalakshmi V, Bhatia P, Kam D, Bassani DG, Sullivan A, Suraweera W, McLaughlin C, Dhingra N, Nagelkerke N; Million Death Study Collaborators. BMJ 2010;340:c62

The aim of the study was to determine the rates of death and infection from HIV in India by analysing a nationally representative survey of deaths. The study population covered 1.1 million homes in India. The population included 123,000 deaths at all ages from 2001 to 2003. The main outcomes were HIV mortality and infection. HIV accounted for 8.1% (99% confidence interval 5.0% to 11.2%) of all deaths among adults aged 25-34 years. In this age group, about 40% of deaths from HIV were due to AIDS, 26% were due to tuberculosis, and the rest were attributable to other causes. Nationally, HIV infection accounted for about 100,000 (59,000 to 140,000) deaths or 3.2% (1.9% to 4.6%) of all deaths among people aged 15-59 years. Deaths from HIV were concentrated in the states and districts with higher HIV prevalence and in men. The mortality results imply an HIV prevalence at age 15-49 years of 0.26% (0.13% to 0.39%) in 2004, comparable to results from a 2005/6 household survey that tested for HIV (0.28%). Collectively, these data suggest that India had about 1.4-1.6 million HIV infected adults aged 15-49 years in 2004-6, about 40% lower than the official estimate of 2.3 million for 2006. All cause mortality increased in men aged 25-34 years between 1997 and 2002 in the states with higher HIV prevalence but declined after that. HIV prevalence in young pregnant women, a proxy measure of incidence in the general population, fell between 2000 and 2007. Thus, HIV mortality and prevalence may have fallen further since this study. HIV attributable death and infection in India is substantial, although it is lower than previously estimated.

is important about this study is not the impressively large numbers – 900 field interviewers recorded symptoms, signs, and key circumstances leading to death for 132, 626 deaths that occurred in a nationally representative sample of 1.1 million homes. Rather, it is that setting up a sample registration system from a national census, as the Government of India has done, creates a framework for reporting causes of death through household visits. This information can be triangulated with data from cohort studies of people living with HIV, results of demographic and health surveys that include HIV testing, sentinel surveillance using HIV testing, and other data to improve national monitoring of HIV and measure the population-level impact of prevention and treatment services.