Time to Death And Predictors Of Mortality Among Adult Hiv/Aids Patients On Art Follow-Up At Health Facilities In Woliso District, Southwest Shoa Zone, Ethiopia: Facility Based Retrospective Cohort Study

Abstract

Background: Improved access to antiretroviral therapy is linked to higher survival and a decrease in mortality. Since rapid expansion of ART program in Ethiopia, the number of AIDS death has shown dramatically decline from 117.7/100,000 in 2001, to 11.73/100,000 in 2019. However, survival status among people with HIV who started ART is variable, predictors vary for this mortality variation according to the existing studies, and there are discrepancies in the results of those studies. Moreover, as far as the author is aware, there was no study conducted in this study area on this topic. Objective: To determine time to death and predictors of mortality among People living with HIV on ART treatment at health facilities in Woliso district, Southwest Shoa Zone, Ethiopia. Methods: Facility based retrospective cohort study was conducted from April 01 to 30, 2023 on PLWHIV who were enrolled on ART from January 01, 2018 to December 30, 2022. To select study participants, simple random sampling technique was used. Nurses through structured abstraction tool using ODK collected data. STATA version 13 was used for data analysis. Kaplan–Meier was used to estimate survival time, and log rank tests were used to compare survival curves. Bivariable and multivariable cox proportional hazard regression analysis was used to determine the predictors of survival time. The Cox-Snell residual plot was used to check the goodness of fit and Cox PH assumption was checked by log log rank test and through graphical assessment. Results were presented in statements, graphs and tables. Result: 720 HIV infected patients on ART were participated in this study. The incidence rate of mortality was 5.1 per 100 person years (95%CI: 4.01–6.50) during the follow-up period. The median time to death was 21 months. Marital status: being divorced (AHR: 6.34 95% CI: 2.05, 19.65), WHO clinical stage III and IV, (AHR: 2.92 95% CI: 3.12, 8.27), ART adherence: fair (AHR: 5.48 95% CI: 2.37, 12.66), and poor (AHR: 3.50 95% CI: 1.72, 7.09) were found to be predictors of mortality. Conclusions: This study found high incidence of mortality among People on ART treatment in comparison to previous studies. Marital status, WHO clinical stage and ART adherence were, identified predictors of mortality. Therefore, enrolment of patients at WHO clinical stage I and II on HIV care service and treatment and good drug adherence is very crucial to improve patients’ survival.