Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre Berhan Referral Hospital, North Showa Zone, Amhara National Regional State: a Retrospective study, 2019.
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Date
2019-06
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Addis Ababa University
Abstract
Background: Although different studies on survival and predictors of mortality amongHIV/AIDS patients after initiation of antiretroviral therapy, there are inconsistencies in the findings of those studies. Furthermore, no research was done in the study area.
Objective:The main objective of this study was to assess the survival and predictors of mortality among adult patients started highly active antiretroviral therapy at Debre Berhan Referral Hospital, North Showa Zone, Amhara National Regional State, 2019. Methodology: This institution
based retrospective study was conducted among the medical records of 447 study subjects’ selected using simple random sampling from January 1
st 2013 to December 302018. The data was collected using structured data abstraction checklist. Kaplan-Meier survival curve and log rank test were used to test for the presence of difference in survival among predictorvariables. Cox regression was used at 5% level of significance to determine the net effect of
each explanatory variable on time to death of patients. Results: Among 447 adult patients,54 patients (12.1%) were died giving a crude death rate of 4.18 per 100 person years (95%CI: 3.20- 5.45). The overall estimated survival rate after initiation of antiretroviral therapy was 81.7 % (95% CI, 75.36- 86.54%) at 72 months of follow up. The independent predictors of mortality were clinical stage IV, (HR=15.6, 95% CI (6.609-36.948), baseline opportunistic infections, (HR=1.86, 95% CI (1.048-3.330)), baseline Hgb<10mg/dl
(HR=4.655, 95CI(2.253-9.619)), baseline CD4<200cells/µL) (HR=4.71, 95% CI (2.275-9.751), the presence of comorbidity (HR= 2.56 95% CI(1.391-4.740)), being widowed(HR=3.475, 95% CI(1.412-8.550)), bedridden functional status (HR=3.069, 95%CI(1.111-8.480)).
Conclusion and recommendation: Patients with opportunistic infections, advanced clinical stage disease, bedridden functional status, baseline
Hgb<10mg/dl, baseline CD4<200cells/µL and comorbidity face higher hazard of dying fromAIDS earlier than their counterparts. Thus, patients with those predictors of mortality should be given special attention, particularly in the first few months after initiating antiretroviral therapy.
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Keywords
HAART, HIV/AIDS, predictors, survival, Debre Berhan Referral Hospital