Large Gains in Adult Life Expectancy in Rural KwaZulu-Natal and the Scale-up of HIV Treatment

Jacob Bor, Harvard School of Public Health
Abraham Herbst, Africa Centre for Health and Population Studies
Marie-Louise Newell, University of KwaZulu-Natal and African Population and Health Research Center (APHRC)
Till Barnighausen, Harvard School of Public Health

The scale-up of antiretroviral therapy (ART) in regions with high HIV prevalence may lead to significant increases in adult life expectancy in the general population. Using data from a population cohort of over 100,000 individuals in rural KwaZulu-Natal, South Africa, where HIV prevalence in 2011 was 29%, we measured changes in adult life expectancy from 2000 through 2011. Prior to the national rollout of ART in 2004, adult life expectancy decreased steadily, reaching 49.2 years in 2003; following the ART rollout, adult life expectancy increased rapidly to 60.5 years in 2011, an 11.3-year gain. The median length of life increased 18.1 years. Using standard values of a statistical life year, the survival benefits of ART far outweigh the costs of providing treatment in this community. These gains in adult life expectancy signify the social value of ART and have important implications for investment decisions of individuals, governments, and donors.