Teshome, Mitiku (2012) Assessment of Determinants of Survival in Adult HIV Patients after Initiation of Antiretroviral Therapy in Nekemte Referral Hospital, Wollega, West Ethiopia:A Retrospective Cohort Study. Masters thesis, Addis Ababa University.
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Abstract
Introduction: Studies identified different determinants of survival which includes, viral load, WHO clinical staging, CD4 cell count, body mass index (BMI), total lymphocyte count (TLC), ART adherence and baseline hemoglobin level. Even if these determinants of survival had been identified, there is no single proven model of determinants for predicting mortality of PLHIV and these determinants are dynamic and change over time due to improving quality of care and support and specific interventions like nutritional interventions. Furthermore, the optimal time to start treatment for HIV/AIDS has been a controversial issue since the introduction of HAART. Objective: To assess determinants of survival in patients living with HIV after starting ART. Methodology: A retrospective cohort study was conducted in Nekemte Referral Hospital. A total of 416 patients’ records enrolled between 2005 to January, 2012 were reviewed consecutively by using patients’ ART unique identification number as a reference. Univariate analysis was used to describe patient’s baseline characteristics. Life table was used to estimate survival after initiation of ART, and log rank test was used to compare survival curves. Cox proportional-hazard regression was used to calculate the bivariate and adjusted hazard rate and then determined independent determinants of time to death. Results: Four hundred sixteen adult patients on ART were followed for a median of 47 months. The mean age was 33.6 years (SD=9.04) and the median weight of the study subjects at the initiation of ART was 51 kg (IQR, 45kg-58kg). The estimated mortality was 4%, 5%, 6%, 7%, and 7% at 6, 12, 24, 36 and 48 months respectively. After adjustment, factors such as, age≥40 AHR=3.364(1.211, 9.348, p=0.020), lower baseline hemoglobin level AHR=0.490 (0.300, 0.801, p=.007), and poor ART adherence AHR=132.3(29.9, 585.8, p<0.001) were confirmed as significant independent determinants of less survival after controlling for other factors while, single marital status AHR=0.285(0.1, 0.84, p=0.023) was protective of HIV mortality. Conclusion: This study has identified the independent significant determinants of less survival in patients living with HIV after initiation of ART which included older age, low baseline hemoglobin level, and poor ART adherence, while single marital status was protective of HIV mortality. These determinants should be taken into account by health care providers to enhance better clinical outcomes.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 21 Nov 2018 08:28 |
| Last Modified: | 21 Nov 2018 08:28 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7547 |
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