Survival and Predictors of Mortality Among HIV Positive Adult Patients on Highly Active Antiretroviral Therapy in Public Hospitals of Kambata Tambaro Zone, Southern Ethiopia: A Retrospective Cohort Study

Background Human Immune Deficiency Virus (HIV) infection remains the leading cause of morbidity and mortality. In Ethiopia, despite test and treat all HIV positives are adopted, a significant number of people eligible for Anti-Retroviral Therapy (ART) show up with advanced disease and at lower CD4 count. There is currently paucity of studies conducted that investigate predictors of mortality among adults on ART in the study area. Objective To explore Survival and predictors of mortality among adult HIV-positive patients on ART in Kambata Tambaro Zone, Ethiopia, from August 2013 to February 2019. Methods A health facility-based retrospective cohort study was conducted among records of 467 adult HIV-positive patients on ART selected using simple random sampling. Data were collected using standardized abstraction tool. Kaplan-Meier, Log rank tests and Cox regression model was applied to estimate survival status and identify predictors of mortality, respectively. Results Of the total 467 study subjects, 59 (12.63%) of them died in the study period. The median follow-up time of the cohort was 40.1 (IQR=13.6-59.0) months. The mortality rate of the cohort was 4.1 per 100 PYO. The overall survival probability of the cohort was 84.38% (95 CI=80.08-87.82) at 66 months. Bedridden function AHR=3.0 (95% CI, 1.44-6.64), Fair-adherence AHR=3.3 (95% CI, 1.50-7.07), Poor-adherence AHR=3.8 (95% CI, 1.88-7.96), presence of OIs AHR=4.2 (95% CI, 1.98-8.50), Late diagnosis (CD4 count >/=350) AHR=3.0 (95% CI, 1.91-6.42) and Immunologic failure AHR=3.5 (95% CI, 1.41-6.29) were independent predictors of time to death in Cox-Regression. Conclusion Late Diagnosis, poor adherence, being bedridden, having OI and Immunologic failure were independently associated with time to death. Early diagnosis to start treatment and emphasizing on close follow-up care to improve treatment adherence should be given special emphasis.