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. 2025 Aug 2;25(1):976.
doi: 10.1186/s12879-025-11397-1.

Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study

Kabali Bwogi  1 , Catherine Nassozi Lwanira  2 , Ivan Kasamba  3   4   5 , Joseph Baruch Baluku  3 , Justine K Nakiwala  3 , Regina Ndagire  2 , Catherine Nassolo  3 , Gerald Wabomba  3 , Christopher Bwanika  3 , Jane Nakawesi  3 , Grace Namayanja  6 , Joseph Kabanda  6 , Julius N Kalamya  6 , Julius Ssempiira  6 , Catherine Ssenyimba  3 , Ronald Mulebeke  3 , Arthur G Fitzmaurice  6 , Barbara Mukasa  3
Affiliations

Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study

Kabali Bwogi et al. BMC Infect Dis. .

Abstract

Background: Despite global efforts to improve HIV care, late diagnosis and delayed antiretroviral therapy (ART) initiation continue to pose mortality risks among people living with HIV (PLHIV) with advanced HIV disease (AHD). This study investigated factors associated with mortality among PLHIV with AHD in rural North-Central Uganda from January 2018 to December 2021.

Methods: We retrospectively reviewed electronic medical records from 18 health facilities, collecting data on demographics and clinical characteristics, including baseline CD4 count, ART regimen, BMI, TB status, TPT use, WHO clinical stage, and viral load. AHD was defined as a baseline CD4 < 200 cells/mm³. Cox proportional hazards modeling identified mortality-associated factors, reported as adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a 5% significance level.

Results: We analyzed 1161 PLHIV with AHD, contributing 1565.6 person-years. There were 84 deaths (7.2%), yielding a mortality rate of 5.4 per 100 person-years (95% CI: 4.33-6.64). Mortality was significantly associated with age ≥ 50 years (aHR 4.16 [1.77-9.77]), no viral load test (aHR 16.23 [7.44-35.39]), viral load non-suppression (aHR 9.05 [3.37-24.29]), CD4 ≤ 50 (aHR 1.91 [1.08-3.39]), no TB prophylaxis (aHR 3.51 [1.83-6.74]), and WHO stage 3 or 4 (aHR 1.91 [1.12-3.27]).

Conclusion: Despite advances in HIV programs, the mortality rate among patients with AHD highlights ongoing challenges. Early identification of AHD patients, regular viral load testing, optimizing ART and ensuring adherence, along with promoting tuberculosis preventive therapy, could help reduce mortality, improve patient outcomes, and achieve HIV epidemic control by 2030.

Keywords: Advanced HIV disease; Mortality; Tuberculosis preventive therapy; Viral load.

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Conflict of interest statement

Ethics declarations. Ethics approval and consent to participate: This activity was reviewed and approved by Mildmay Uganda Institutional Review Board (REC REF No. 0804–2018), as well as the U.S Centers for Disease Control and Prevention (U.S CDC) under 45 C.F.R. part 46.101(c); 21 C.F.R. part 56. The data used were aggregated and individual patients could not be identified. We therefore did not seek informed consent. The Mildmay Uganda Research and Ethics committee provided a waiver of consent for the use of secondary data, because data were sourced from publicly accessible Electronic Medical Records (EMR) platform. All methods were performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve stratified by age group among PLHIV with advanced HIV disease initiated on ART in rural Uganda (2018–2021)
Fig. 2
Fig. 2
Kaplan–Meier survival curve stratified by CD4 category among PLHIV with advanced HIV disease
Fig. 3
Fig. 3
Kaplan–Meier survival curve stratified by tuberculosis preventive therapy (TPT) use among PLHIV with advanced HIV disease
Fig. 4
Fig. 4
Kaplan–Meier survival curve stratified by WHO clinical stage at ART initiation among PLHIV with advanced HIV disease
Fig. 5
Fig. 5
Kaplan–Meier survival curve stratified by viral load suppression status among PLHIV with advanced HIV disease
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References

    1. The Global HIV/AIDS Epidemic. KFF. 2023. https://www.kff.org/global-health-policy/fact-sheet/the-global-hiv-aids-.... Accessed 12 Jan 2024.
    1. Global HIV. & AIDS statistics—Fact sheet. https://www.unaids.org/en/resources/fact-sheet. Accessed 13 Jan 2024.
    1. World Health Organization. HIV data and statistics. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/s.... Accessed 28 May 2025.
    1. Uganda AIDS. Commission. Uganda AIDS Commission| We share challenges together| Ending HIV/AIDS by 2030. https://uac.go.ug/. Accessed 31 Aug 2024.
    1. Post FA, Szubert AJ, Prendergast AJ, Johnston V, Lyall H, Fitzgerald F, et al. Causes and timing of mortality and morbidity among late presenters starting antiretroviral therapy in the REALITY trial. Clin Infect Dis. 2018;66(suppl2):S132–9. - PMC - PubMed

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