Predictors of mortality among HIV positive adults on highly active antiretroviral therapy in Attat primary hospital, Southern Ethiopia: A retrospective cohort study

Abstract

Background: Over the last decade, Ethiopia has made significant progress in combating the HIV epidemic. Even though there have been improvements in service delivery and utilization since the introduction of Antiretroviral Treatment services in Ethiopia, mortality among Human Immunodeficiency Virus (HIV) infected patients on Highly Active Antiretroviral Treatment (HAART) remains high, with mortality rates varying from place to place. Therefore, this study intends to explore the predictors of mortality among adult HIV-positive patients on active anti-retroviral therapy in Attat primary hospital. Methods:  Retrospective cohort study was conducted from May 15 to June 15, 2021.  Records of 422 HIV-positive adults, who had been taking antiretroviral treatment between January 2016 to January 2021, were included in the study. The data were collected and entered by an Open Data Kit (ODK) and exported to STATA version 14.1 for analysis. Kaplan-Meier and a log-rank test were used to compare survival probability. Cox proportional hazards regression was used to predict the risk of death. Results: Of the total of 422 participants 239 (56.6%) were female. The median age was 34.5 years with an interquartile range of 26 to 40.25 years. The median follow-up time was 33 months with an IQR of 18 to 48 months. The overall mortality rate was 4.71/100 person-years at risk. Bedridden functional status (AHR: 2.658; 95%CI: 1.177-6.328), hemoglobin level <10 g/dl (AHR: 3.525; 95%CI: 1.387-8.954), clinical-stage IV (AHR: 3.294; 95%: 1.290-8.411) and active TB during treatment (AHR: 3.108; 95%CI: 1.478-6.534) were the main factors associated with mortality. Conclusion: Bedridden, functional status, low hemoglobin level, advanced clinical stage, and Tuberculosis co-infection were significant predictors of mortality for patients under ART. The mortality rate needs to be reduced by emphasizing individuals with advanced clinical stage, anemia, bedridden functional status, and Tuberculosis co-infection. Keywords: HIV, ART, Mortality, Ethiopia