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Assessment of antiretroviral treatment outcome in public hospitals, South Nations Nationalities and Peoples Region, Ethiopia
Abstract
Background: The outcome of antiretroviral treatment, survival patterns and associated determining factors in public hospitals are not well known. Thus a longitudinal study is vital to understand the pattern of survival and treatment outcome.
Objective: To assess the outcome of antiretroviral treatment in rural public hospitals in South Nations, Nationalities and Peoples Region, Ethiopia.
Method: A historical retrospective cohort study design was used for patients visiting hospitals from January 1, 2005 to January 31, 2009. A total of 5,664 patient records were examined from eight randomly selected public hospitals. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.
Results: The median age was 30 years and 73.6% were in the age group 25-40 while the higher HIV risk age group 14-24 covered only 12.8%. The proportion of females was 56.3%. The cumulative proportions of survivals were 92%, 90%, 88% and 86% at months 6, 12, 24 and 36 respectively. The hazard of death was higher in male (AHR: 1.632, CI: 1.309-2.034) and those who had a baseline CD4 cell count < 50 cells /ml compared to these with a count of above 200 (AHR: 3.176, CI: 2.304- 4.434). Patients with WHO stage IV at baseline had a higher risk of death compared to these with a WHO stage I (AHR: 5.603, CI: 1.753-17.905).
Conclusions: There is an indication of improvement of survival in the patient population. An advanced disease stage, Low CD4 cell count, gender and timing of ARV regimen combinations had significant contribution in determining a longer survival time. Priority should thus be given to identify HIV-infected individuals and start ART earlier in the course of their illness. [Ethiop. J. Health Dev. 2011;25(2):102-109]
Objective: To assess the outcome of antiretroviral treatment in rural public hospitals in South Nations, Nationalities and Peoples Region, Ethiopia.
Method: A historical retrospective cohort study design was used for patients visiting hospitals from January 1, 2005 to January 31, 2009. A total of 5,664 patient records were examined from eight randomly selected public hospitals. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.
Results: The median age was 30 years and 73.6% were in the age group 25-40 while the higher HIV risk age group 14-24 covered only 12.8%. The proportion of females was 56.3%. The cumulative proportions of survivals were 92%, 90%, 88% and 86% at months 6, 12, 24 and 36 respectively. The hazard of death was higher in male (AHR: 1.632, CI: 1.309-2.034) and those who had a baseline CD4 cell count < 50 cells /ml compared to these with a count of above 200 (AHR: 3.176, CI: 2.304- 4.434). Patients with WHO stage IV at baseline had a higher risk of death compared to these with a WHO stage I (AHR: 5.603, CI: 1.753-17.905).
Conclusions: There is an indication of improvement of survival in the patient population. An advanced disease stage, Low CD4 cell count, gender and timing of ARV regimen combinations had significant contribution in determining a longer survival time. Priority should thus be given to identify HIV-infected individuals and start ART earlier in the course of their illness. [Ethiop. J. Health Dev. 2011;25(2):102-109]
