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Observational Study
. 2017 Feb;27(Suppl 1):63-71.
doi: 10.4314/ejhs.v27i1.7s.

Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study

Daniel Fekade  1 , Teklu Weldegebreal  2 , Alula M Teklu  3 , Melake Damen  4 , Saro Abdella  5 , Nega Baraki  4 , Bekele Belayhun  6 , Eyoel Berhan  7 , Amha Kebede  8 , Yibeltal Assefa  8
Affiliations
Observational Study

Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study

Daniel Fekade et al. Ethiop J Health Sci. 2017 Feb.

Abstract

Background: In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013.

Methods: Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 - July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death.

Results: A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/µl (interquartile range (IQR) 78-205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7-5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4-6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037).

Conclusion: There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.

Keywords: Antiretroviral therapy; Ethiopia; HIV clinical cohort; Survival.

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Figures

1 - A
1 - A
Kaplan-Meier survival estimates of the cohort
Figure 1B
Figure 1B
Survival estimate of the Cohort by CD4
Figure 1C
Figure 1C
Survival estimates by WHO clinical stages
See this image and copyright information in PMC

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