Journal des maladies tropicales et de la santé publique

Abstrait

Survival and Predictors of Mortality among Adults on Antiretroviral Therapy in Selected Public Hospitals in Harar, Eastern Ethiopia

Tesfaye Digaffe, Berhanu Seyoum and Lamessa Oljirra

In resource-poor countries, access to ART has improved during the last years and mortality rates among treated patients have declined substantially. However, compared to patients in high-income countries, patients in resourcepoor countries are at higher risk of death in the early months of treatment. To avoid such early deaths, the identification of possible risk factors and potential causes of deaths are important. A retrospective cohort study was conducted among a cohort of 655 People Living with HIV/AIDS (PLWHA) on ART in three in selected public hospitals in Harar, Eastern Ethiopia. From the total PLWHA participants, 438 (66.9%) were female and the median age of patients were 33 years. The median follow-up period was 38 months. During the follow up period, 74 (11.4%) patients were deceased. The cohort was followed for 1913 Person-Years of observation. Total mortality rate over the follow up period was 3.9 per 100 person-years. Most of deaths (n=36, 49%) occurred in the first 3 months of ART initiation. Three baseline factors could be independently identified: World Health Organization (WHO) clinical stage III and IV (Hazard Ratio (HR) =2.13), CD4 counts lower than 50cells/µl (HR=2.34), not taking base line Cotrimoxazole Prophylaxis Treatment (CPT) (HR=2.46). Despite optimizing ART delivery in Ethiopia, a proportion of early deaths among patients with very advanced disease are not likely to be preventable with ART. This may require extensive and detailed study in resource poor countries. Thus, a more fundamental issue and the greater challenge is the need for early HIV diagnosis and provision of appropriate longitudinal HIV care prior to ART eligibility.