Incidence and predictors of mortality within the first year of antiretroviral therapy initiation at Debre-Markos Referral Hospital, Northwest Ethiopia: A retrospective follow up study

BACKGROUND: Acquired Immunodeficiency Syndrome (AIDS) is one of the most fatal infectious diseases in the world, especially in Sub-Saharan Africa, including Ethiopia. Even though Antiretroviral therapy (ART) significantly decreases mortality overall, death rates are still highest especially in the first year of ART initiation. OBJECTIVE: To assess the incidence and predictors of mortality within the first year of ART initiation among adults on ART at Debre-Markos Referral Hospital, Northwest Ethiopia. METHODS: A retrospective follow-up study was conducted among 514 newly enrolled adults to ART from 2014 to 2018 at Debre-Markos Referral Hospital. Patients’ chart number was selected from the computer using a simple random sampling technique. Data were entered into EPI- INFO 7.2.2.6 and analyzed using Stata 14.0. The mortality rate within the first year was computed and described using frequency tables. Both bivariable and multivariable Cox-proportional hazard models were fitted to show predictors of early mortality. RESULTS: Out of 494 patient records included in the analysis, a total of 54 deaths were recorded within one year follow-up period. The overall mortality rate within 398.37 person years (PY) was 13.56 deaths/100 PY with the higher rate observed within the first three months. After adjustment, rural residence (Adjusted Hazard Ratio (AHR) = 1.97; 95% CI: 1.05–3.71), ≥ 6 months pre-ART duration (AHR = 2.17; 95% CI: 1.24–3.79), ambulatory or bedridden functional status at enrolment (AHR = 2.18; 95% CI: 1.01–4.74), and didn’t take Cotrimoxazole preventive therapy (CPT) during follow-up (AHR = 1.88; 95% CI: 1.04–3.41) were associated with early mortality of adults on ART. CONCLUSION: Mortality within the first year of ART initiation was high and rural residence, longer pre-Art duration, ambulatory or bedridden functional status and didn’t take CPT during follow-up were found to be independent predictors. Hence, giving special attention for patients from rural area and provision of CPT is crucial to reduce mortality.