Determinants of Survival among Adults on Antiretroviral Therapy in Adama Hospital Medical College, Oromia Regional state, Ethiopia

Background: Acquired immune deficiency syndrome (AIDS) is one of the leading causes of mortality in sub-Saharan Africa. Successful use of Anti-retroviral treatment (ART) suppresses Human immunodeficiency virus (HIV) replication; consequently slowing down disease progression, improving immunity and delaying mortality. Even though ART was implemented long ago, improvement in survival among patients was not adequately determined in institutions providing this service. Thus, the aim of this study was to assess determinants of survival among adult patients on ART in Adama Hospital Medical College, Oromia regional state, Ethiopia. Method: A retrospective cohort study was employed among 384 clients selected by systematic random sampling method from clients enrolled for antiretroviral therapy from September 2010 to August 2011 in Adama Hospital medical College. The cohort was followed for three years. Descriptive statistics was used to summarize socio-demographic variables. Kaplan-Meier survival analysis was used to estimate survival probability after antiretroviral treatment initiation and Cox-proportional hazard model was used to identify predictors of mortality using SPSS Version 20. Result: A total of 384 ART naïve adult patients who were initiated on ART were followed for 3 years. About 61% of the participants had baseline CD4 count <200 cells/µl and 76% of them were WHO clinical stage 1 or 2. Fifty-nine percent of participants completed the survival period. Over the 3 years of follow up, 384 patients contributed 792.4-person years of observation (PYO) with the mortality rate of 2.1/100 PYO. The median survival time for the cohort was 24 months while that of dead and lost to follow up (LTF) cases were 1 month and 3 months respectively. The predictors of mortality using the real case assumption model were functional status (ambulatory and bed ridden) and World Health Organization (WHO) clinical stage (3/4). In using worst-case assumption, lack of formal education, divorced marital status, and functional status (ambulatory and bedridden) were predictors of mortality. Conclusion: More than half of the participants were females and higher proportion of females were younger than 35 years. Higher proportion of the study participants were initiated on ART at advanced disease stge. Death and LTF occurred within the first 3 months of follow up. Thus, to increase the survival of patients on ART, strengthening screening program for early initiation of ART and increasing awareness on early treatment seeking are essential.