Treatment outcomes and their determinants in HIV patients on Anti-retroviral Treatment Program in selected health facilities of Kembata and Hadiya zones, Southern Nations, Nationalities and Peoples Region, Ethiopia

Abstract

Background

Ethiopia has been providing free Antiretroviral Treatment (ART) since 2005 for HIV/AIDS patients. ART improves survival time and quality of life of HIV patients but ART treatment outcomes might be affected by several factors. However, factors affecting treatment outcomes are poorly understood in Ethiopia. Hence, this study assesses treatment outcomes and its determinants for HIV patients on ART in selected health facilities of Kembata and Hadiya zones.

Methods

A retrospective cohort study was conducted on 730 adult HIV/AIDS patients who enrolled antiretroviral therapy from 2007 to 2011 in four selected health facilities of Kembata and Hadiya zones of Southern Ethiopia. Study subjects were sampled from the health facilities based on population proportion to size. Data was abstracted using data extraction format from medical records. Kaplan-Meier survival function was used to estimate survival probability. Cox proportional hazards regression model was used to identify factors associated with time to death.

Result

Median age of patients was 32.4 years with Inter Quartile Range (IQR) [15, 65]. The female to male ratio of the study participants’ was 1.4:1. Median CD4 count significantly increased during the last four consecutive years of follow up. A total of 92 (12.6 %) patients died, 106(14.5 %) were lost to follow-up, and 109(15 %) were transferred out. Sixty three (68 %) deaths occurred in the first 6 months of treatment. The median survival time was 25 months with IQR [9, 43]. After adjustment for confounders, WHO clinical stage IV [HR 2.42; 95 % CI, 1.19, 5.86], baseline CD4 lymphocyte counts of 201 cell/mm ³ and 350 cell/mm ³ [HR 0.20; 95 % CI; 0.09−0.43], poor regimen adherence [HR 2.70 95 % CI: 1.4096, 5.20], baseline hemoglobin level of 10gm/dl and above [HR 0.23; 95 % CI: 0.14, 0.37] and baseline functional status of bedridden [HR 3.40; 95 % CI: 1.61, 7.21] were associated with five year survival of HIV patients on ART.

Conclusion

All people living with HIV/AIDS should initiate ART as early as possible. Initiation of ART at the early stages of the disease, before deterioration of the functional status of the patients and before the reduction of CD4 counts and hemoglobin levels with an intensified health education on adherence to ART regimen is recommended.