The scale-up of antiretroviral therapy (ART) in resource-limited settings is based on a public-health approach to the provision of such treatment.1 Impressive progress has been made since 2004, and WHO's interim target of treating 3 million people has now been reached. The public-health goal of scaling up ART is not only to improve outcomes in those receiving treatment but also to reduce morbidity and mortality at the population level.2 In the absence of vital registration, and in settings where a large proportion of deaths occur outside the health system, population effects are difficult to assess. High-quality cohort studies of patients starting ART in resource-limited settings are increasingly available— eg, within the framework of the International epidemiological Databases to Evaluate AIDS (leDEA).3-4 However, such cohort studies do not directly measure the population effectiveness of treatment.
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