Abstract

Background: Antiretroviral Therapy (ART) has markedly improved survival of people living with HIV/AIDS (PLWHA). Yet, the full potential benefits of the therapy depend on understanding of predictors of mortality among PLWHA. The aim of this study was to assess predictors of mortality among adult PLWHA.

Methods: A retrospective cohort study was conducted among adult PLWHA who enrolled to HIV care clinic from September 1st, 2012 to August 30, 2016 in, Southwest Ethiopia by simple random sampling from the data base. Multivariable Cox Regression analyses were used to identify predictors of mortality using 95% confidence interval (CI) and at P values.

Results: Record review of 676 adult PLWHA who were on ART follow up was conducted. The cumulative incidence among females was 16.8% (64/382). The total extents of follow up were 28,209 person-months with overall incidence rate of 11 deaths per 1000 person-months observation. The predictors of mortality among the PLWHA were found to be severe undernutrition (AHR: 3.7; 95% CI: 1.6, 6.7) and moderate malnutrition at base line of ART (AHR: 2.5; 95% CI: 1.7, 7.5), younger age (AHR:2.1; 95% CI: 1.7, 3.3), female (AHR: 2.8; 95% CI: 2.1,4.6), single (AHR: 2.6; 95% CI: 1.8, 3.8), divorced (AHR: 2.4; 95% CI: 1.3,3.9) Illiterate (AHR: 2.5; 95% CI: 1.9, 4.8), lack of disclosure (AHR: 3.6; 95%: 1.7, 9.5), TB infection (AHR: 2.9; 9%: 1.5, 5.5), WHO clinical stage IV (AHR: 3.7; 95% CI: 1.7, 5.3), getting treatment out of catchment area (AHR:3.6; 95% CI: 1.5,5.4), rural residence (AHR:2.1; 95% CI:1.4, 3.3), substances use (AHR: 1.8; 95% CI:1.4, 5.4),  immunological (AHR:1.7; 95% CI: 1.3, 2.7), and abnormal liver test (AHR: 4.1; 95% CI: 2.4, 6.7).

Conclusions: Undernourishment, social disadvantages and lack of supports,  advanced clinical stage, immunological, clinical failures, moderate malnutrition at base line of ART, Younger age, female, single, divorced, low level of education, lack of disclosure, TB infection, WHO clinical stage IV, getting treatment out of the catchment area, substance use, and Abnormal liver test Were found to be predictors of mortality. Intervening, those factors as routine and part of “appointment spacing model care” can improve survival of PLWHA.

Key words: Adult, Appointment Spacing Modals, ART, PLWHA, Predictors, Jimma zone