Early mortality of HIV-patients on ART from a low-prevalence country in Latin America: results from Nicaragua
F. Shakir1,2, D. Nuñez Aguirre3,4, M. Villanueva5, B. Lainez Paredes5, I. Moreno Rodríguez3,4, R. Jean-Baptiste2,6
1University Research Co. LLC., Bethesda, United States, 2USAID Health Care Improvement Project, Bethesda, United States, 3University Research Co., LLC, Managua, Nicaragua, 4USAID Health Care Improvement Project, Managua, Nicaragua, 5Hospital España, SILAIS Chinandega, Chinandega, Nicaragua, 6University Research Co. LLC., Oxford, United Kingdom
Background: With efforts currently underway to decentralize antiretroviral therapy (ART) in Nicaragua, a low-prevalence HIV epidemic country (0.2% HIV-Prevalence, UNAIDS 2004), mortality and losses to follow-up (LTFU) should be considered as program outcome measures.
Methods: This retrospective study examined survival and LTFU rates of patients on ART in an adult treatment program at Hospital España in Chinandega, one of the largest public HIV/AIDS treatment programs in Nicaragua. Chart reviews yielded data for all patients on ART from the time of treatment initiation until death, LTFU, or transfer-out. Kaplan-Meier analysis was used to calculate survival times.
Results: The study population included all 166 patients (females (42%); median age 29 years) ever receiving ART between 2005 and 2010 at Hospital España, contributing 3160 person-months to the analysis. Of 166 ART patients, 117 (70.5%) were still receiving treatment at the time of the study, 33 (20%) died, 13 (7.8%) transferred to another facility and 3 (2%) were LTFU. Patients had received a median of 14.4-months of treatment. Survival was 95.1% at 1-month (95%-CI 90.4-97.5), 84.5% at 3-months (95%-CI 77.9-89.2), 81.5% at 6-months (95%-CI 75.3-87.4), 79.8% at 12-months (95%-CI 73.2-86) and 75.6% at 24-months of treatment (95%-CI 70.3-84.2). Mortality at 12-months following ART initiation was 20.2%. Of 33 deaths, more than three quarters (76%) occurred within three months of initiating treatment. Patients initiating treatment in advanced stages of HIV/AIDS had 10.7 greater odds of death (adjusted-OR 10.7, 95% CI 4.0, 28.1) compared to patients initiating treatment earlier in the course of disease.
Conclusion: Early mortality rates of patients on ART in this study are considerably higher than those reported by other Latin-American countries. Increased odds of death in patients starting treatment during advanced HIV disease emphasize the urgent need to identify and address barriers to early treatment initiation.
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