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