Predictors of mortality among adult HIV infected patients on HAART at St. Paul's Hospital Millennium Medical College : Facility Based Case Control Study

Abstract

ABSTRACT Back ground Although efforts have been made to reduce AIDS-related mortality by providing antiretroviral therapy services, still people are dying while they are on treatment due to several factors. This study aimed to investigate the predictors of mortality among adult antiretroviral therapy users in Saint Paul's Hospital Millennium Medical College. Objective To assess predictors of mortality among adult HIV infected patients on HAART at Saint Paul's Hospital Millennium Medical College. Method A hospital-based case control study was conducted from January 2013- December 2018 on adult HIV infected patients on HAART having follow up at ART clinic of Saint Paul' Hospital Millennium Medical College, Addis Ababa, Ethiopia. Cases were clients started ART and died during the period while controls were clients started ART and alive during the same period. Data were collected from 336 of ART clients. For cases, the first 84 dead clients were taken and a ratio of three controls to one case was taken using simple random sampling method. Data were entered, cleared and analysed using SPSS version25. Frequencies and percentages were used to describe study subject’s characteristics. Bivariable logistic regression was used to determine an association between categorical variables and multivariable logistic regression was used to identify factors associated with ART client’s mortality. Results of 336 study participants, 84 were cases and 252 were controls. More than half of cases 49 (58.3 %) were females. Similarly, more than half of controls 171 (68.4 %) were also females. Most of cases 37 (44%) were under age group of 35-44 in years while that of controls 107(42.8 %) predominantly under age group of 25-34 in years. Overall mortality rate was 5.7/100 persons years and pattern of death was decreasing over 5 years still ART clients with WHO stage III and IV, CD 4 count less than 350 cells/mm3, platelet counts less than 150 X 1000 cells/𝜇L, TB coinfection, other opportunistic diseases, not being given CPT and poor adherence had higher odds of death compared to their respective counterparts. Conclusion Overall mortality rate was high and the pattern of mortality was generally decreasing. Advanced WHO clinical stage, low CD 4 count, low platelet count, presence of TB and other opportunistic diseases at ART initiation, not being given CPT and poor adherence were factors associated with mortality among ART clients. Initiation of ART at early WHO clinical stage, prevention and control of TB and other opportunistic infections, early work up of underlying causes of low platelet and treatment and counseling and improving adherence are recommended interventions to health care workers.