Determinants of survival time among HIV positive patients after being initiated on Combivir. The case of Gulu Regional Referral Hospital in Uganda
Abstract
This study was aimed at identifying determinants of survival time among HIV positive patients after
being initiated on Combivir. Majority of clients at this facility are initiated on Combivir as a preferred
first line regimen and it’s based on this that we would like to assess effectiveness of this drug. The
study assessed both demographic and clinical factors of 200 HIV positive clients initiated on Combivir
at Gulu Regional Referral Hospital between 1st/01/2005, and 31st/12/2013.
In addition to primary data collected, secondary data was extracted from the Gulu ART clinic data base
and analyzed using univariate, bivariate and multi variate methods. This included running descriptive
statistics, using the log rank test and fitting a Cox proportional hazard model to determine factors that
had a significant association with the survival time of the patients.
The findings show that survival was different across various categories of weight, levels of education,
ART Adherence and baseline CD4 count. The survival of patients increased with increasing weight
while the hazard reduced by 66% among patients that attained tertiary education compared to those
with no education. Patients with good ART adherence had 46% reduced hazard compared to their
counterparts with fair adherence while those who were initiated on Combivir with baseline CD4 >=350
had their hazard reduced by 13%. Survival time was not significantly different across various
categories of gender and employment status (p>0.05). This implies that these factors seemed not to
affect the duration of survival for HIV patients who have been initiated on Combivir.
The study concluded that determinants of survival among HIV positive patients who have been
initiated on Combivir are: Weight of the patient, level of Eeducation, ART adherence and CD4 count.
The study recommended that initiation of Combivir be done early for HIV positive patients when CD4
is >=350 as recommended by WHO and national HIV treatment guidelines (2016) in Uganda. The
drug should also be introduced when the patient weight is relatively high (>50kgs among adults) and
Intensive Adherence Counselling should be emphasised to ensure good adherence