Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study

Balogou, Agnon Ayélola Koffi; Saka, Bayaki; Kombaté, Damelan; Kombaté, K.; Mouhari-Touré, A.; Akakpo, S.; Singo, A.; Pitché, P.

doi:10.1258/td.2011.110138

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…Thus, in Togo most patients begin ART once they meet the clinical criteria for AIDS. While this is consistent with other studies from sub-Saharan Africa [2, 11] it will not be true in other more affluent areas or possibly in Africa over time.…”

Section: Discussionsupporting

confidence: 91%

“…Our study could not determine further why these factors contributed to loss to follow-up. Three of the factors — WHO stage [12, 13], opportunistic infections [11, 14, 15], and among a subset death — are all consistent and illustrate that in our setting the most ill patients become lost to the medical care system. The other factors require more investigation to explain.…”

Section: Discussionmentioning

confidence: 66%

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Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Saka¹,

Landoh²,

Patassi³

et al. 2013

Pan Afr Med J

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IntroductionNational programs are facing challenges of loss to follow-up of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). We sought to identify risk factors associated with early loss to follow-up among HIV-infected patients on ART in Togo and the outcome of such patients.MethodsThis was a retrospective cross-sectional study using medical records of all patients older than age 15 years enrolled at 28 treatment centers who were on ART programs and who were lost to follow-up from 2008 to 2011.ResultsOf the 16,617 patients on ART, 1,216 (7.3%) were lost to follow-up. Most (94.1%) were infected with HIV-1 and 32.6% were in WHO stage III or IV. The median CD4 count was 118/mm3 (IQR: 58-178 cells/mm3). No telephone number was mentioned in the medical records of 212 patients. Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR = 1.6; 95%CI: 1.2-2.2), female sex (OR = 1.8; 95%CI: 1.3-2.5), WHO stage III or IV (OR = 1.7; 95%CI: 1.3-2.2), existence of an opportunistic infection (OR = 2.3; 95%CI: 1.5-3.1), and follow-up in a public centre (OR = 1.9; 95%CI: 1.2-3.3).ConclusionThis study identified several factors associated with lost to follow-up during the first 6 months of ART, and confirmed high mortality among these patients. The National AIDS Program should strengthen medical support of PLWHA in Togo including active case follow-up.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 66%

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Saka¹,

Landoh²,

Patassi³

et al. 2013

Pan Afr Med J

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“…Globally, different causes of mortality among PLHIV have been documented. Wasting syndrome, tuberculosis, acute bacterial infections, malignancies, anemia, cerebral toxoplasmosis and immune reconstitution disease were the major AIDS related causes of death [25, 46]. While cardiovascular disease, liver disease and non-AIDS defining cancer were the non-AIDS related causes [47, 48].…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013

Angdembe¹,

Rai²,

Bam³

et al. 2019

PLoS ONE

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Background In Nepal, since 2004, 19,388 people living with HIV (PLHIV) have been enrolled on antiretroviral therapy (ART). The aim of this study was to measure mortality rate and to identify predictors of mortality in adult (≥15 years) PLHIV who initiated ART between 2004 and 2013 in five large ART centers of Nepal. Methods This retrospective cohort study of 3,799 (60.5% male) adult PLHIV uses secondary data collected from standard ART registers. Time from ART initiation (baseline) to death or censoring (loss to follow-up or December 31, 2013) was assessed. Mortality rates per 100 person-years were calculated. Kaplan-Meier models were used to estimate the probability of mortality over time. Predictors of mortality were determined using Cox-regression models. Results The overall mortality rate was 6.98 (95% CI: 6.46–7.54) per 100 person-years, 4.11 (95% CI: 3.53–4.79) in females and 9.14 (95% CI: 8.36–9.99) in males. Mortality rates were higher in early months after ART initiation, particularly in the first three months. Baseline predictors of mortality were ART center, male gender (adjusted HR = 2.08, 95% CI: 1.69–2.57), residence outside the ART district (AHR = 1.45, 95% CI:1.19–1.76), World Health Organization clinical stage III (AHR = 1.67, 95% CI: 1.13–2.46) and IV (AHR = 2.21, 95% CI: 1.45–3.36), bedridden <50% time in the last month (AHR = 1.92, 95% CI: 1.52–2.41), bedridden >50% time in the last month (AHR = 3.82, 95% CI: 2.95–4.94), lower bodyweight/kg (AHR = 1.04, 95% CI: 1.03–1.05), CD4 count <150 cell/mm 3 (AHR = 2.14, 95% CI: 1.05–4.34) and treatment not switched to second-line regimen (AHR = 3.05, 95% CI: 1.35–6.90). Conclusions Mortality rates were higher soon after ART initiation, particularly in males and gradually decreased over time. Poor baseline clinical characteristics were significantly associated with higher mortality. Increased ART coverage with decentralization of sites to lower levels including community dispensing, differentiated and improved service delivery and initiation of ART at a less advanced disease stage may reduce early mortality.

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“…Recent studies from inpatient settings suggest morbidity and mortality remain high among HIV-infected individuals. [2][3][4] Outcomes may differ by the available level of care at each facility and by the rate of uptake of ART. Additional data are needed to identify preventable risk factors for mortality in the ART era that may be addressed by targeted interventions.…”

Section: Introductionmentioning

confidence: 99%

HIV-related mortality at a district hospital in Botswana

et al. 2016

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We reviewed mortality data among medical inpatients at a tertiary hospital in Botswana to identify risk factors for adverse inpatient outcomes. This review was a prospective analysis of inpatient admissions. All medical admissions to male and female medical wards were recorded over a six-month period between 1 November 2011 and 30 April 2012. Data collected included patient demographics, HIV status (positive, negative, unknown), HIV testing history, HIV related treatment and serological history, admission and discharge diagnoses, and mortality status at final discharge or transfer. Of 972 patients admitted during the surveillance period, 427 (43.9%) were known to be HIV-positive on admission, 144 (14.8%) were known to be HIV-negative, and 401 (41.3%) had an unknown HIV status. Of those with unknown status, 131 (32.7%) were tested for HIV during admission and among these 35 (27.5%) were HIV-positive. Including patients with known mortality status following transfer, 172 (17.9%) patients died during the hospitalization. Death occurred in 105 (23%) of known HIV-positive patients, compared with 31 (13%) of known HIV-negative patients (p = 0.002, HR = 1.56 in adjusted analyses). Among HIV-positive patients who died, a low CD4 cell count (<200 cells/mm) was associated with death. Overall, patients who died had significantly more neurological and respiratory-related presenting complaints than patients who survived. In conclusion, we identified higher overall mortality among HIV-positive patients at a tertiary hospital in Botswana, and low rates of in-hospital HIV testing and antiretroviral therapy initiation. These data demonstrate that despite available antiretroviral therapy in the population for over a decade, HIV continues to add excess burden to the hospital system and adds to inpatient mortality in Botswana.

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Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study

Cited by 5 publications

References 11 publications

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013

HIV-related mortality at a district hospital in Botswana

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