Survival and Socio-demographic determinants of Mortality in Adult HIV/AIDS patients in Myanmar: A registry based retrospective cohort study 2005-2015

            With increasing coverage of ART among people living with HIV/AIDS, their survival has been improved in recent years. However, the country is still facing a substantial number of AIDS related deaths. Although there were studies which investigated about the impact of clinical factors on mortality of HIV/AIDS patients, the survival rate and the factors influencing mortality among HIV/AIDS patients on ART in Myanmar including socio-demographic factors are poorly understood. This study assesses the survival rate of adult HIV-infected patients on ART and identifies the determinants of their mortality including socio-demographic factors. A registry-based retrospective cohort study was applied by reviewing baseline and follow-up records of patients on ART between June 1, 2005 and May 31, 2015 at the HIV-Specialist Hospital in Yangon, Myanmar. Time to death was the main outcome measure in the study and the outcome date was December 31, 2015. Life Table Analysis was used to estimate cumulative survival, hazard rate and probability of dying, Kaplan- Meier survival curves were constructed and accessed the difference in survival of each categorical variables, and Cox proportional hazards model was fitted to identify the determinants of mortality. There were 8038 people registered for ART and 7995 samples were included in the analysis. The median follow up period was 25 months (IQR= 11 to 56 months). At the end of follow up, 909(11.4%) were died, 5850 973.17%) were alive, 951(11.9%) were lost to follow-up and 285(3.6%) were transferred out to other ART clinics. Mortality rate was 3.95 deaths per 100-person-years of follow up period.  The cumulative probabilities of survival at 6 months, 1 year, 5 years and 10 years of ART were 0.92, 0.907, 0.86 and 0.82 respectively. Age at the start of ART of ≥35 years (AHR=1.29), Male sex (AHR=1.24), No OI prophylaxis (AHR=4.6), <95% ART adherence (AHR=14.81), changed ART regimen during the course (AHR=0.44), WHO clinical staging 3 and 4 (AHR=1.39), bedridden functional status (AHR=2.11) and baseline CD4 count of <200/mm3 (AHR=1.63) were factors influencing mortality of HIV-infected people on ART after adjusting other covariates. There was a high rate of mortality within six months after initiation of ART. Hence, priority should be given to the patients during the first six months after initiation of ART. The study will provide information to policy makers and HIV/AIDS program implementers to implement appropriate interventions for the improvement of survival of HIV/AIDS patients in Myanmar.

 

Key words: Survival rate, socio-demographic factors, adult mortality, HIV/AIDS patients on ART