Background:
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It has passed thirty years since the deadly pandemic; HIV/AIDS started changing the picture of the world. The pandemic has largely affected sub-Saharan Africa. The Antiretroviral therapy (ART) that has been started recently in many African countries through generous funding of international donors has conveyed a glimpse of hope for most. Ethiopia is one of the hardest hit countries by the pandemic. Since free ART service has started in 2005, only 33% of those in need have accessed the treatment. The early outcome of the rapid scale up service is not investigated well. The objective of the paper is to investigate the early survival outcomes of ART scale up service in Ethiopia by utilizing routine hospital data.
Methods:
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All adult HIV/AIDS patients who were started on antiretroviral therapy in Shashemene and Assela Hospitals from January 1st 2006 to May 31st , 2006 were included and followed for 2 years. Data were extracted from standard ART and PreART registers and Follow-up forms. Data was entered on Epi-infoversion 3.5.1 and analyzed with both STATA10 and Epi-info 3.5.1. Kaplan Meier curve was used to estimate survival probability and Coxproportional hazard was applied to determine predictors of mortality in the cohort. Twoalterative models were used in determining predictors of mortality. Model I (real case assumption) in which only dead cases were used as events and Model II was worst scenario
assumption which lost cases are considered as events.
Results:-
Two hundred seventy two ART naive patients were followed for 2 years. The median age of patients was 33 years and 57% were female. Eighty five percent had CD4 <
200 cells/µl with median CD4 count of 103 cells/µl. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during 2 years period and 48(18%) has
lost from follow-up. Majority of deaths occurred in the first 4 months of treatment. Inunivariate analysis, the two years survival was significantly associated with clinical stage of the disease, baseline hemoglobin and CPT at orbefore ART initiation in both models of analysis. In addition functional status and baseline weight were found to be significantly associated with 2 years survival in model II assumption. The median CD4 count and body weight showed marked improvement in first 6 month followed by poor and stagnant change afterwards in the follow-up period.
Conclusion:-
The cohort had similar mortality as compared to other settings but high rate of lost follow up. The study has shown the feasibility of free ART scale up service in Ethiopian setting by reducing mortality which was comparable with other better settings. But the high lost to follow up finding demands an urgent action in improving the underlying patient retention mechanisms and tracing of lost cases. The poor CD4 recovery and body weight improvement after 6 months of follow-up could be a clue for problems of drug adherence and possible treatment failure which has to be studied in detail and addressed accordingly. The tradition of utilizing routine data should be encouraged in our setting for urgent actions and
clinical audits.