Mortality and Its Predictors among Adult Human Immune-Deficiency Virus-Infected Patients Attending Their Antiretroviral Treatment at Health Centers, Addis Ababa, Ethiopia: Multicenter Retrospective Cohort Study

Abstract

Introduction. In resource-limited settings such as Ethiopia, where the prevalence of HIV/AIDS is high, a number of factors, including economic, demographic, behavioral risk, and health factors, affect how long people with AIDS are treated with antiretroviral therapy. Since several aspects of the clinical setup may have an impact on ART patients’ survival, this study was conducted in health centers. Determining the mortality rate and survival factors among adult HIV-infected patients receiving ART at health centers in Addis Abeba’s Kirkos subcity is the primary goal of this study. Methods. A retrospective cohort study was carried out at the health center in Addis Abeba’s Kirkos subcity. The source population consisted of all adult HIV-positive patients who were being followed up between December 1, 2014, and October 30, 2019. A total of 665 samples were collected using a computer-generated simple random sampling method in each of the three health centers that were chosen by a lottery system depending on the number of patients in the follow-up. Trained data collectors took the information out of the patient card and the electronic database. Regressions using the Kaplan‐Meier and Cox proportional hazards were employed. Results. The incidence of death rate in adult HIV-positive patients was 55 (8.5%) fatalities, translating to a death rate of 3.25 per 100 person-years. The majority of deaths occurred within 6 months of ART initiation. Predictors of mortality were: age above 50 years (AHR = 4.90, 95% CI: 2.00, 11.98), tuberculosis comorbidity (AHR = 3.46, 95% CI: 1.23, 3.33), lack of drug adherence (AHR = 1.76, 95% CI: 1.23, 3.33), co-trimoxazole therapy (AHR = 2.59, 95% CI: 1.37, 4.90), and CD4 cell count less than 200/dl (AHR = 2.77, 95% CI: 1.30, 5.92). Conclusion and Recommendation. Adult HIV-positive individuals had an incidence of the death rate of 55 (8.5%), which equates to 3.25 deaths per 100 person-years. Age category over 50, TB comorbidity, WHO stage IV, lack of medication adherence, co-trimoxazole therapy, body mass index under 18.5 kg/m2, and CD4 cell count under 200/dl were predictors of mortality. Therefore, it is important to focus on prevention, early identification, and treatment of HIV/AIDS for these predictors at all levels of the HIV/AIDS chronic care package in order to increase survival.

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

“…The participants contributed 91,866.861 PYO, and 4,050 deaths were recorded. Mean or median survival time was reported in 13 of the 35 studies [ 31 , 33 , 34 , 40 , 41 , 43 , 46 , 47 , 53 , 55 , 58 , 59 , 64 ]. There were two subnational studies as part of the Advanced Clinical Monitoring for HIV/AIDS in patients with HIV infection [ 52 , 60 ].…”

“…There were two subnational studies as part of the Advanced Clinical Monitoring for HIV/AIDS in patients with HIV infection [ 52 , 60 ]. Six of the studies were conducted in the Amhara region [ 30 , 42 , 44 , 51 , 54 , 59 ], four in the Oromia region [ 32 – 34 , 55 ]; three in Addis Ababa city administration [ 38 , 43 , 53 ]; 12 in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) [ 31 , 35 , 36 , 39 – 41 , 45 , 46 , 57 , 62 – 64 ], three in Tigray [ 37 , 49 , 50 ], three in Harari region [ 47 , 48 , 61 ], one each in Afar [ 56 ] and Somalia [ 58 ] regions. The overall proportion of mortality was 10.13%, and estimates from individual studies suggest the cumulative incidence of mortality ranged from 4.43% [ 33 ] to 29.68% [ 30 ].…”

“…yes 6 3.10 (1.31, 7.32) 0.010* 94.3 < 0.001 0.068 6 CD4 + T-cell count ( n = 8315) [ 24 , 30 , 37 , 40 – 44 , 47 , 48 , 51 , 55 , 59 , 61 , 63 , 66 ] < 200 vs. ≥ 200 cells/mm 3 16 3.23 (2.29, 4.75) < 0.001* 88.8 < 0.001 0.260 7 Hemoglobin (in gram/dl) ( n = 2745) [ 37 , 39 , 41 – 44 , 47 , 48 , 51 , 53 , 54 , 59 ] < 10 vs. ≥ 10 12 2.63 (1.32, 5.22) 0.006* 94.9 < 0.001 0.692 8 HIV clinical stages ( n = 5581) [ 23 , 30 , 36 , 37 , 40 – 43 , 47 , 48 , 51 , ...…”