Rate and Predictors of Mortality Among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, North West Ethiopia

Abstract

Background: Human immunodeficiency virus/Acquired immunodeficiency syndrome is a chronic communicable disease with devastating global socio-economic, and political impacts commonly affecting the young and early adult populations. Ethiopia is doing well in controlling HIV/AIDS epidemic infection among African countries. This study set out to determine the mortality rate and its predictors among adults on antiretroviral therapy at Debre Markos Referral Hospital, northwest Ethiopia.

Methods: A hospital-based retrospective follow-up study was conducted from February to March 2018. A computer-generated simple random sample selected 480 cards of patients on antiretroviral therapy who were enrolled between February 2010 to January 2018. Epi-data Version 4.2 software was used for data entry and SPSS Version 25 for management and analysis. An adjusted hazard rate with a 95% confidence interval was used to identify significant predictors of mortality.

Results: The mortality rate was about 3.9 per 100 person-years. Cotrimoxazole prophylactic therapy (AHR: 2.99; 95% CI: 1.58, 5.70), being single (AHR: 2.37: 95% CI: 1.15, 4.87), non-disclosed status (AHR: 7.77; 95% CI: 3.76, 16.06), anemia (AHR: 2.16; 95% CI: 1.14, 4.09), bedridden (AHR: 6.11; 95% CI: 2.42, 15.41) or ambulatory (AHR: 2.16; 95%: 1.04, 4.51), presence of opportunistic infections (OIs) (AHR: 5.02; 95% CI: 1.70, 14.83) and tuberculosis (TB) co-infection (AHR: 5.57; 95% CI: 2.23, 13.88) were the significant predictors.

Conclusion and recommendation: This study had a high mortality rate. Being single, bedridden, TB coinfection, anemia, and cotrimoxazole prophylaxis were the predictors of mortality. Therefore, psychological support and close follow-up for single, non-disclosed, non-adherent patients and early detection and treatment of anemia, tuberculosis, and OIs to reduce mortality is recommended.

Keywords: ART; Debre Markos; Ethiopia; HIV; mortality; predictors of mortality.

Figure 1

Survival probability of patients on ART (n=458) starting from initiation of ART until the end of study period among PLHIV, at Debre Markos Referral Hospital, northwest Ethiopia, January 2018.

Figure 2

Survival status of HIV positive patients based on their marital status in Debre Markos Referral Hospital, northwest Ethiopia, January 2018.

Figure 3

Survival status of adults based on HIV disclosure status category upon initiation ART in Debre Markos Referral Hospital, northwest Ethiopia, January 2018.

Figure 4

Survival status of HIV positive adults based on functional status upon initiation ART in Debre Markos Referral Hospital, northwest Ethiopia, January 2018.