Predictors of survival status among people Living with hiv after antiretroviral therapy Initiation, in jijiga zone, somali region, Eastern ethiopia

Abstract

Back ground: Antiretroviral Therapy ART has shown to delay progression to AIDS, improve survival, and result in a greater and more sustained virologic and immunologic response. In addition it reduces morbidity and mortality, however, the durability of the effectiveness of HAART remains to be delineated because various factors influence its effectiveness. Objective: To investigate the survival status and identify the potential predictors of mortality after initiation of ART among PLHIV in Jigjiga Karamara hospital, Jigjiga zone, Somali region, Eastern Ethiopia. Methods: A retrospective follow up study was conducted. Data was collected from February 2014 to March 2014. Secondary data all clients started ART treatment between January 2009 and December 2013 who fulfill inclusion criteria have been included in this study. Both descriptive and inferential statistics methods were done. Hazard ratios were computed for potential covariates after checking the assumption of Cox PH model. All variables significant at P < 0.25 level in the bivariate analysis were included in the final multivariable model and independent predictors was identified by making use of AHR, 95%CIs, and p value <0.05 as a cut-off point for statistical significance. All analyses was made using SPSS version 16.0 for windows. Result: Study participants were 822 adult patients who started ART in Kharamara hospital. They were followed for a median of 22 months. This study demonstrated that simple laboratory and clinical data, prior to ART initiation, can predict patients increased risk of mortality. The identified independent significant predictors of survival status after initiation of ART were being male sex (AHR=2.55, 95%CIs (1.02-2.52)), bedridden functional status (AHR=3.75, 95%CIs (1.33-10.59)), advanced WHO staging III (AHR=3.48, 95%CIs (1.05- 11.54)) and IV (AHR=4.13, 95%CIs (1.21-14.10)), low CD4 count < 50cells/µl(AHR=7.57, 95%CIs (3.38-16.9)) and <50-99cells/µl (AHR=5.85, 95%CIs (2.57-13.)), lower BMI<18Kg/m2 (AHR=6.11, 95%CIs (2.06-18.14))and poor ART adherence(AHR=9.59, 95%CIs (5.03-18.20)). Conclusion & Recommendation: The study cohort had similarly lower mortality rate when compared to other earlier studies conducted in Ethiopia and other African countries. This emphasizes the importance of ART in reducing morbidity and mortality among PLHIV. However, a lot needs to be done regarding patient retention and adherence.