Determinants of Survival in Adult HIV Clients on Antiretroviral Therapy in Lawra and Jirapa Districts of Upper West Region, Ghana

Abstract

We describe the rate of death and identify the determinants of survival in a cohort of adults starting antiretroviral therapy (ART) in 2 hospitals in Upper West Region, Ghana. Kaplan-Meier model was used to estimate the survival probability after ART initiation and Cox proportional hazard model used to assess the relationship between baseline variables and mortality. A total of 91 clients who were initiated on ART in both hospitals participated in the study. Clients staged in the World Health Organization (WHO) clinical stage III/IV had a higher risk of mortality than those staging I/II (hazard ratio [HR] of 3.93). Hemoglobin value at baseline with a cutoff ≥12 g/dL for women (and ≥13 for men) was strongly associated with mortality in participants with an HR of 3.87 (95% confidence interval [CI]: 0.71-21.19) for severe anemia, 2.11 (95% CI: 0.45-9.93) for moderate anemia, and 0.88 (95% CI: 0.16-4.82) for mild anemia. Anemia and WHO staging were independent predictors of mortality.

Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana

“…Significant differences in survival probabilities were observed among specific variables using the Kaplan-Meier survival curve. WHO stages I and II had the highest survival probability and this finding agreed with studies in Ghana's Upper West Region and Oromiyaa, Ethiopia where WHO stages I and II had the highest survival probability than stages III and IV [17,19]. The prognosis of the disease at WHO stages I and II at the time of diagnosis and subsequent initiation of the ARVs early could account for the above findings.…”

“…The overall survival probabilities for the first and fifth years were 0.9376 and 0.8049, respectively. These findings, projected high survival probabilities when compared with another study conducted in the Lawra and Jirapa districts in the Upper West Region of Ghana where the survival probability at the end of the three years was 0.795 per 1000 person-years [ 17 ]. The findings were similar to the findings of a study conducted in the Henan province of China from 2005 to 2014 where the cumulated survival for the first and fifth year were 93.7% and 85.3% respectively [ 18 ].…”

“…The findings were similar to the findings of a study conducted in the Henan province of China from 2005 to 2014 where the cumulated survival for the first and fifth year were 93.7% and 85.3% respectively [18]. The reason for the higher survival probabilities in this study could be due to the removal of all barriers to the initiation of ARVs and early diagnosis due to the 90-90-90 policy which was not the case during the period of the study by Okyere et al [17].…”

“…The reason for the higher survival probabilities in this study could be due to the removal of all barriers to the initiation of ARVs and early diagnosis due to the 90-90-90 policy which was not the case during the period of the study by Okyere et al . [ 17 ].…”

Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study

“…Evidence shows that the early mortality rate in sub-Saharan Africa varies from 8 to 26%, with the majority of deaths occurring in the first few months [10]. Similarly, findings from Ghana indicated that about 44.4% of deaths occurred prior to the first month of initiation of ART and the WHO clinical stage, CD4 counts and hemoglobin levels were identified as indicators of disease progression [11].…”