Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003–15

Abstract

BackgroundSeveral studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia.MethodsWe have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses.ResultsA total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up—an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25–50 years, base line CD4 count, developing immunologic failure, bedridden functional status, and no history of HIV testing before diagnosis.ConclusionsThe great majority of deaths were documented in the first two years of ART, and several predictors of early HIV mortality were also for the overall mortality when discontinuation was assumed as event or censored. Considering the above population, interventions to improve HIV program in the first two years of ART follow up should be improved.

Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe

“…However, there was a significant increase in the probability of deaths related to malignancies and NCDs over time. Similar to other studies, we identified that most deaths were within a year of ART initiation into the NC HIV treatment program [17] and the major risk factors for death were poor baseline clinical and immunological status.…”

<p>Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study</p>

“…The sample size was determined using double population proportion formula by considering CD4 count (≥200 cells/ μL with the proportion of 0.047 vs <200 cells/μL with the proportion of 0.084) as an independent predictor based on a study done in Jimma university teaching hospital. 22 The sample size was calculated using two-sample proportion formulas in Epi-Info version 7 for Windows. 23 The calculation was based on the assumption of type I error of 5%, and power of 80%, providing a sample size of 447.…”

“…The result of the multivariable analysis revealed that those who had opportunistic infection had a 1.86-times higher chance of death compared to those who had not (aHR=1.86, 95% CI=1.048-3.33). Patients who had Ethiopia, 19 and Jimma University Teaching Hospital, South-West Ethiopia, 22 to which the mortality rates were reported as 1.9, 1.75, and 2.17 per person-years, respectively. The observed difference in mortality rates might be due to the difference in sample size, duration of the study period, and the time duration each cohort contributed.…”

“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

“…The prevalence rate of HIV among Ethiopian women with concurrent sexual partners (five or more) is even higher, being 6% [2]. In a 12-year retrospective cohort study to assess the complete HIV care continuum at a clinic dispensing antiretroviral therapy (ART) in Jimma, southwest Ethiopia, we found that 59% (3119 of 5299) of HIV patients on ART were females, implying a higher burden of HIV among this segment of the population [3]. Furthermore, we found that delayed presentation for HIV care [4], discontinuation from ART [5], immunologic failure [6], and HIV-related mortality [3] were higher among females than males.…”