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 73.6were 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; 88and 86at 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 thecourse of their illness. [