Knowledge of mortality trends
and predictors among HIV-positive patients in the era of highly active
antiretroviral therapy (HAART) in resource poor settings is still limited.
The
aim of this study was to describe trends and predictors of mortality among
HIV-positive patients in the era of HAART in Uganda. Data from 2004 to 2013 for
adult HIV-positive patients (≥15 years) obtaining care and treatment from the
AIDS Support Organization in Uganda were reviewed for mortality. Descriptive
statistics were analyzed by frequencies and cross tabulations. Calendar period
was used as a proxy measure for HAART exposure and a time plot of the
proportion of HIV-positive patients reporting dead per year was used to
describe the trends. Logistic regression was used to determine the predictors
of mortality at bivariate and multivariate levels, respectively.
We included in
the analysis 95,857 HIV positive patients; 64% were female with median age of
33 years (interquartile range 27-40). Of these 36,133 (38%) were initiated on
ART and a total of 4279 (4.5%) died; 19.5% (835/4279) of those who died had an
opportunistic infection.
Overall, mortality first increased between 2004 and
2006 and thereafter substantially declined.
Mortality was relatively higher in Eastern Uganda compared to other
geographical areas. Male gender, older age (>45 years), being from Eastern
or Northern Uganda, having none or primary education, being unemployed,
advanced immunodeficiency (CD4 count <100 cell/µL or WHO stage III or IV)
and underweight (<45 kg weight) at HAART initiation and calendar period
2004-2008 were significant predictors of mortality (P<0.001).
Overall, the
expanding coverage of HAART is associated with a declining trend in mortality
among HIV positive patients in Uganda. However, mortality trends differed
significantly by geographical area and men remain potentially at higher risk of
death probably because of delayed initiation on ART. There is urgent need for
men targeted interventions for improved ART performance.
Full article at: http://goo.gl/d3xRIJ
By:
- 1Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda ; Department of Public Health, School of Health Sciences, Mountains of the Moon University , Fort Portal, Uganda.
- 2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda.
- 3The AIDS Support Organisation , Kampala, Uganda.
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