Incidence and Predictors of Mortality Among Adults ART Users on Universal Test and Treat Approach in a Public Health Facility, South Ethiopia 2023
Zinabu Dawit*, Serekebrehan Sahile, Yigrem Getaneh, Habtamu Samuel, Fiker Bojola, Mesrach Hailu, Bahiru Mulatu, Wodimageng Taye, Samuel Dessu, Zinash Tantu, Desalegn Dishole and Asmelash Dagne
ABSTRACT
Background: Universal "test and treat approach" (UTT) is a program that commends for all populations those diagnosed HIV positive receive early treatment not considering their CD4 count and WHO clinical stage. However, there are limited studies that assess the incidence and predictors of mortality among adults ART users on universal test and treat approach in public health institution.
Objective: This study was amid to assess the incidence and predictors of mortality among adults ART users on universal test and treat approach in public health facility in South Ethiopia
Methods: Institution-based retrospective cohort study was conducted at Public hospitals in Southern Ethiopia with a total of 802 randomly selected records of ART enrolled adults from March 1, 2013, to February 31, 2020. Data were extracted by using a standardized checklist by trained health professionals, then it was cleaned, entered by epidata version 4.2, and analyzed by STATA version 14. The Cox model was used to estimate survival differences across different study variables.
Results: A total of 790 patients were followed for 1490.8 person-year (PY) of observation. The overall incidence density rate (IDR) of death in the cohort was 3 per-100-PY. The incidence of death was significantly higher in the CD4-based and WHO stage program than the UTT program. The death among CD4-based and WHO stage programs were 3.7 times higher than the UTT program. The log-rank test and Kaplan-Meier survival curve indicated patients enrolled in the UTT program survived longer than patients enrolled in the CD4-based and WHO clinical stage program (log-rank X2 test = 17.6 p-value = 0.001). WHO clinical stage, functional status, Program of ART, New opportunistic infection, Adherence to ART drugs, and Initiation of IPT were predicted mortality from HIV infection.
Conclusion: Mortality was significantly reduced in the universal test and treat program. Hence, intervention to further reduce deaths has to focus on early initiation of treatment and strengthening universal test and treat programs.
