Survival Pattern and determinants of mortality among Adult HIV positive patients Highly Active Antiretroviral Therapy in Sawla Town public health facilities, SNNPR, Southern Ethiopia

Abstract

Background: In resource poor countries like Ethiopia the survival of patients treated with antiretroviral therapy depends on factors that might vary greatly with socio demographic, clinical and behavioral risk factors. However, factors affecting survival among adult HIV positive patients in Ethiopia are not fully investigated. Moreover, mortality has been high particularly in the first three to six month of initiating antiretroviral therapy. To avoid such early deaths, the identification of possible risk factors and potential causes of deaths are important. Methods: A retrospective cohort study was conducted using 455 records of patients who were enrolled on antiretroviral therapy in Sawla General Hospital and Sawla Health center from September 2013 to August 2018. Socio demographic, clinical, immunological, behavioral data and date of antiretroviral treatment initiation including date of follow up status were extracted. Predictor variables were identified by fitting Cox’s proportional hazard model using backward stepwise method and statistical significance variables were declared based on p-value < 0.05. Results: A total of 455 adult HIV/AIDS patients on ART contributed to 867 person year of observation and 299(65.7%) were alive & on treatment, 78(17.1%) were lost follow up, 44(9.7%) were transfer out and 34 (7.5 %) were died. The estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 & 60 months of follow up period, respectively. Out of 34 deaths, 20 (58.8 %) were died within the first 6 months of antiretroviral therapy initiation. The overall incidence rate of mortality was 3.92 per 100 person years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI: 1.21-11.4), bedridden functional status (AHR: 17.4, 95% CI: 6.21-48.79), poor ART drug adherence (AHR: 4.52,95% CI: 2.05- 9.96), Tuberculosis co- infection (AHR: 4.1, 95% CI: 1.84-9.13), non-disclosure(AHR: 4.9, 95% CI: 1.82-12.89) & severe anemia (AHR: 5.1, 95% CI: 1.81-14.21) were predictor of survival and statistically significant association with mortality in HIV patients. Conclusion: This study had identified the independent significant predictors of survival in patients living with HIV/AIDS after initiation of HAART. These factors include Patients with older age, tuberculosis co infection, bedridden functional status and severe anemia (hemoglobin less than 7 mg/dl) should be monitored closely by their clinicians.