Correlates of aids-related mortality among patients on antiretroviral therapy in Uganda

Abstract

In this “test and treat” era of HIV and AIDS management, the persistently higher mortality rate among PLWH compared to non-HIV individuals in low-income countries remains questionable. This study aimed to investigate the reasons for AIDS-related deaths employing Accelerated Failure Time models which have not been fully exploited. Secondary data from AHF, Uganda Cares Masaka Regional Referral Hospital was used to study the influence of socio-demographic, personal and behavioural factors and, patient clinical features on time to death. A retrospective study was carried out considering patients who were diagnosed with HIV and started ART from January 2009 through January 2020. The Kaplan-Meier (KM) estimate of the survival function, log rank chi test and multivariate log normal Accelerated Failure Time model were employed. p<0.05 was considered. Our results revealed that, being male (TR=0.299, p=0.000), disclosure of HIV status to other family members (TR=0.311, p=0.006), being at an advanced stage of disease progression stage III (TR=0.126, p=0.001) and stage IV (TR=0.023, p=0.000), and having viral load count greater or equal to 1000 copies/ml (TR=0.523, p=0.028) were associated with shorter time of survival. In addition, patients who attended the voluntary counselling sessions had longer survival time compared to those who did not attend (TR=2.261, p=0.006) and patients on ART whose body weight is 50 kg and above had longer time of survival compared to those with weight below 50kg. In conclusion, being male, not attending counselling sessions, disclosure of HIV status to other family members rather than spouse or sexual partners, weighing below 50kg, being at an advanced stage of disease progression (stage III and stage IV) and having viral load count greater or equal to 1000 copies/ml at baseline are associated with shorter survival time and dying earlier. Therefore, future research should focus on interventions targeting patient population groups with less survival time yet are already initiated on ART.