Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care in Southwest Ethiopia.

Abstract

Introduction: Antiretroviral Therapy has markedly improved survival of people living with human Immune virus. Yet, the full potential benefits of the therapy depend on understanding of predictors of mortality among PLWHA. The aim of this study was to assess predictors of mortality among adult PLWHA in Jimma Zone Public Hospitals. Methods A retrospective cohort study was conducted among 676 adult PLWHA who enrolled to ART clinic from September 1st, 2012 - August 30, 2016. Multivariable Cox Regression analysis was used to identify predictors of mortality using 95% confidence interval (CI) and at P value ≤ 0.05 cut of point. Results The total person-time contributed was 28,209 person-months with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). The predictors of mortality were found severe Undernourishment (AHR: 3.7; 95% CI: 1.6, 6.7) and moderate malnutrition (AHR: 2.5; 95% CI: 1.7, 7.5) at base line, younger age (AHR:2.1; 95% CI: 1.7, 3.3), female (AHR: 2.8; 95% CI: 2.1,4.6), single (AHR: 2.6; 95% CI: 1.8, 3.8), divorced (AHR: 2.4; 95% CI: 1.3,3.9) Illiterate (AHR: 2.5; 95% CI: 1.9, 4.8), lack of disclosure (AHR: 3.6; 95%: 1.7, 9.5), WHO clinical stage IV (AHR: 3.7; 95% CI: 1.7, 5.3), seeking treatment out of catchment area (AHR:3.6; 95% CI: 1.5,5.4), rural residence (AHR:2.1; 95% CI:1.4, 3.3), and immunological failure (AHR:1.7; 95% CI: 1.3, 2.7). Conclusions Poor nutritional status at baseline, advanced HIV disease, occurrence of treatment failure, female sex, substance use disorders, lack of social support, immunological failures, clinical failures, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of “appointment spacing model care” can improve survival of PLWHA.

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

“…Globally, 38 million people living with HIV, among 2.2 million new infections, and 690,000 deaths in 2019 [1]. The African continent contributes to about 11% of death in the global population-related HIV [2]. Ethiopia is among the African countries significantly affected by the HIV pandemic [3].…”

“…Although Ethiopia is close to reaching HIV epidemic control [4], treatment failure remains a major challenge due to discontinuation of ART, and poor ART adherence. Furthermore, patients endure long traveling distances, high transportation costs, long waiting times to get ART service, persistent HIV-related stigma and discrimination, poor attitudes by healthcare workers, and high caseloads within ART facilities which contribute to overall poor ART service in Ethiopia [2,5,6].…”