Effect of late HIV diagnosis on HIV-related mortality among adults in general hospitals of Central Zone Tigray, northern Ethiopia: a retrospective cohort study

Abstract

Background

The global incidence of HIV infection is not significantly decreasing, especially in sub-Saharan African countries, including Ethiopia. Though there is availability and accessibility of free HIV services, people are not being diagnosed early for HIV, and hence patients are still dying of HIV-related causes. This research is aimed at verifying the effect of late diagnosis of HIV on HIV-related mortality in Central Zone Tigray, Ethiopia.

Methods

A retrospective cohort study among adult (≥15 years old) HIV patients in three general hospitals of Tigray was conducted. Record reviews were carried out retrospectively from 2010 to 2015. Sample size was determined using stpower Cox in Stata software. Data were entered into EpiData version 3.1 software and transferred to Stata version 12 for analysis. Both bivariable and multivariable analyses were performed using Cox regression model to compare the HIV-related mortality of exposed (cluster of differentiation 4 cells count <350 cells/mm³) and nonexposed (≥350 cells/mm³) patients using adjusted hazard ratio (AHR) at 95% confidence interval (CI).

Result

In all, 638 HIV patients were analyzed, contributing 2,105.6 person-years. Forty-eight (7.5%) patients died of HIV-related causes with a mortality rate of 2.28 per 100 person-years. In the multivariable Cox regression model, patients with late diagnosis of HIV had a higher risk of mortality (AHR =3.22, 95% CI: 1.17–8.82) than patients with early diagnosis of HIV. Rural residence (AHR =1.96, 95% CI: 1.05–3.68), unemployment (AHR =2.70, 95% CI: 1.03–7.08), bedridden patients (AHR =2.98, 95% CI: 1.45–6.13), ambulatory patients (AHR =2.54, 95% CI: 1.05–6.15), and baseline hemoglobin level of <11 mg/dL (AHR =3.06, 95% CI: 1.51–6.23) were other independent predictors of mortality.

Conclusion and recommendations

Late diagnosis of HIV increased HIV-related mortality. Rural residence, unemployment, bedridden and ambulatory patients, and baseline hemoglobin level <11 mg/dL were also independent predictors of HIV-related mortality.

Keywords:

• HIV
• early/late diagnosis
• CD4 cell count
• HIV-related mortality
• Tigray
• Ethiopia

Acknowledgments

We would like to express our gratitude to Aksum University College of Health Sciences, Department of Public Health for giving us this opportunity to do this research. We would also like to acknowledge Aksum St Mary, Adwa, and Abi-Adi general hospitals for their permission to get the required data. Finally, we appreciate the assistance of all the data collectors and supervisors for carefully undertaking their roles.

Author contributions

HB and MA designed the study; HB, MA, FA and TA were involved in data management and write up of the study. HB, MA, FA, TA and SH analyzed the data and discussed the findings. MA wrote the original draft of the manuscript. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work. All authors were involved and approved the final draft of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.