Predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy at Suhul Hospital, Tigrai, Northern Ethiopia: a retrospective follow-up study

Abstract

BackgroundEthiopia is striving to achieve a goal of “zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths.” However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART).MethodsA retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality.ResultsThe median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality.ConclusionThe overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.

Predictors of Mortality Among Adult HIV-Infected Patients Taking Antiretroviral Therapy (ART) in Harari Hospitals, Ethiopia

“… 29 , 30 In the present study due to possibly similar reasons, the patients who did not take IPT for at least six months had a higher risk of death from HIV/AIDS. This finding was consistent with study findings from the Tigray region, 8 Amhara region, 31 Addis Ababa, 32 Southern Ethiopia, 33 and Zimbabwe. 34 This similarity might deep-rooted the value of taking IPT for at least six months to reduce TB incidence that indirectly results in the reduction of risk of death from HIV/AIDS…”

“…Different studies showed that the survival status of HIV-infected patients might be affected by advanced HIV stage, severe immunodeficiency, co-morbidity, low hemoglobin count, low body mass index, low CD4 counts, malnourished, poor functional status, low economic status and not taking prophylaxis treatment. 8–14 However, these prognostic factors are not well characterized in Ethiopia because of which it is hard to identify the most contributing factors for mortality among patients on ART follow-up. A better understanding of these factors would allow care providers in the closer follow-up in high-risk patients for the reduction of early mortality.…”

Incidence and predictors of mortality within the first year of antiretroviral therapy initiation at Debre-Markos Referral Hospital, Northwest Ethiopia: A retrospective follow up study

“…Overall, 10.93% (95% CI: 8.72–13.62) of study participants were known to have died within a year of ART initiation. This is in line with studies conducted in Tigray (13.5%) and Somalia (9.8%), Ethiopia [ 24 , 28 ], and also study in India with 11.9% [ 29 ]. This similarity with Tigray and Somalia, Ethiopia, could be that they used similar HIV care and treatment guideline.…”

“…Sample size was estimated by using single population proportion formula through EPI INFO statistical package version 7.2.2.6 with the assumption of 95% level of confidence, proportion (P) of 12.5% [ 24 ], 3% marginal error, and Power 80%. With these assumptions calculated sample size became 467 and by considering 10% expected incomplete record, the final sample size was 514.…”

Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

“…[7][8][9][10][11][12] Ethiopia also shares the high burden of HIV/AIDS-related mortality ranging from 5.9% in Goba Hospital to 18% in the Oromia region. [13][14][15][16][17][18][19] Prior studies revealed sociodemographic, clinical and treatment related factors such as age, 20 sex, 9,10,21 educational level, 15,21 marital status, 9,19 body mass index (BMI), 12,18,19 opportunistic infections (OIs), 18 world health organization (WHO) clinical stage, 9,[16][17][18][19] isoniazid preventive therapy (IPT), 15,18 Hemoglobin (Hgb) level, 9,12,19,21,22 functional status, 16,17,19 CD4 count, 9,16,19,22 disclosure status, 17 and adherence 20,22 are significantly associated with mortality in adult HIV/AIDS patients on ART.…”