Abuto Wondimu, Abera Admas, Gobena Tesfaye, Dingeta Tariku, Markos Melese
Public Health Emergency Management, Kembata Tembaro Zonal Health Department, Durame, Southern Nations Nationalities Peoples' Region, Ethiopia.
School of Public Health, Haramaya University, Harar, Ethiopia.
HIV AIDS (Auckl). 2021 Mar 12;13:271-281. doi: 10.2147/HIV.S299219. eCollection 2021.
Human Immune Deficiency Virus (HIV) infection remains the leading cause of morbidity and mortality. In Ethiopia, despite test and treat all HIV positives are adopted, a significant number of people eligible for Anti-Retroviral Therapy (ART) show up with advanced disease and at lower CD4 count. There is currently paucity of studies conducted that investigate predictors of mortality among adults on ART in the study area.
To explore Survival and predictors of mortality among adult HIV-positive patients on ART in Kambata Tambaro Zone, Ethiopia, from August 2013 to February 2019.
A health facility-based retrospective cohort study was conducted among records of 467 adult HIV-positive patients on ART selected using simple random sampling. Data were collected using standardized abstraction tool. Kaplan-Meier, Log rank tests and Cox regression model was applied to estimate survival status and identify predictors of mortality, respectively.
Of the total 467 study subjects, 59 (12.63%) of them died in the study period. The median follow-up time of the cohort was 40.1 (IQR=13.6-59.0) months. The mortality rate of the cohort was 4.1 per 100 PYO. The overall survival probability of the cohort was 84.38% (95 CI=80.08-87.82) at 66 months. Bedridden function AHR=3.0 (95% CI, 1.44-6.64), Fair-adherence AHR=3.3 (95% CI, 1.50-7.07), Poor-adherence AHR=3.8 (95% CI, 1.88-7.96), presence of OIs AHR=4.2 (95% CI, 1.98-8.50), Late diagnosis (CD4 count >/=350) AHR=3.0 (95% CI, 1.91-6.42) and Immunologic failure AHR=3.5 (95% CI, 1.41-6.29) were independent predictors of time to death in Cox-Regression.
Late Diagnosis, poor adherence, being bedridden, having OI and Immunologic failure were independently associated with time to death. Early diagnosis to start treatment and emphasizing on close follow-up care to improve treatment adherence should be given special emphasis.
人类免疫缺陷病毒（HIV）感染仍然是发病和死亡的主要原因。在埃塞俄比亚，尽管采用了检测并治疗所有HIV阳性患者的策略，但仍有相当数量符合抗逆转录病毒疗法（ART）条件的人出现疾病进展且CD4细胞计数较低。目前在该研究地区，针对接受ART治疗的成年人死亡率预测因素的研究较少。
探讨2013年8月至2019年2月期间，埃塞俄比亚坎巴塔坦巴罗地区接受ART治疗的成年HIV阳性患者的生存情况及死亡预测因素。
基于医疗机构记录进行回顾性队列研究，通过简单随机抽样选取467例接受ART治疗的成年HIV阳性患者。使用标准化提取工具收集数据。分别应用Kaplan-Meier法、对数秩检验和Cox回归模型来估计生存状况并确定死亡预测因素。
在467名研究对象中，有59例（12.63%）在研究期间死亡。队列的中位随访时间为40.1（四分位间距=13.6 - 59.0）个月。队列的死亡率为每100人年4.1例。在66个月时，队列的总体生存概率为84.38%（95%置信区间=80.08 - 87.82）。卧床功能AHR = 3.0（95%置信区间，1.44 - 6.64），依从性一般AHR = 3.3（95%置信区间，1.50 - 7.07），依从性差AHR = 3.8（95%置信区间，1.88 - 7.96），存在机会性感染AHR = 4.2（95%置信区间，1.98 - 8.50），晚期诊断（CD4细胞计数≥350）AHR = 3.0（95%置信区间，1.91 - 6.42）以及免疫失败AHR = 3.5（95%置信区间，1.41 - 6.29）是Cox回归中死亡时间的独立预测因素。
晚期诊断、依从性差、卧床、患有机会性感染和免疫失败与死亡时间独立相关。应特别强调早期诊断以开始治疗，并注重密切随访护理以提高治疗依从性。
