Survival and Its Determinants of HIV/AIDS Patients Receiving Antiretroviral Therapy in Two National Referral Hospitals in Eritrea: A Retrospective Cohort Study.

Introduction: HIV/AIDS continues to be a significant public health concern globally, particularly in low- and middle-income countries. In Eritrea, despite access to antiretroviral therapy (ART), many people living with HIV (PLHIV) continue to experience early mortality. Furthermore, survival analysis among those patients has not been conducted. Thus, this study aimed to assess the survival rates and identify the determinants of PLHIV on ART in two national referral hospitals in Eritrea.

Methods: A retrospective cohort study was used to recruit PLHIV aged 15 years or above who started ART between August 2005 and December 31, 2020, in Halibet National Referral Hospital (HNRH) and Orotta National Referral and Teaching Hospital. Data were extracted from a database and patients' medical records (patients' medical cards, laboratory results, and registries). The Kaplan-Meier estimator and the extended Cox proportional hazards regression were used for analysis.

Results: Of 3646 study participants, 11.5% died, 55.7% were on follow-up, 14.2% transferred out, and 18.5% lost to follow-up. The mortality rate was 1.32 per 100 person-years (95% CI: 1.20-1.44). Furthermore, by the end of the follow-up period, 79.7% of the patients survived. Of those who died, 70% and 60% survived their first and second year of ART initiation, respectively. Age above 45 years (HR=1.58, 95% CI: 1.05-2.37), ambulatory functional status (HR=2.49, 95% CI: 1.79-3.47), bedridden functional status (HR=2.88, 95% CI: 1.77-4.69), poor adherence (HR=1.57, 95% CI: 1.09-2.28), fair adherence (HR=2.19, 95% CI: 1.66-2.89) were predictors of poor survival. Conversely, CD4 count (cell/mm) 101-200 (HR=0.38, 95% CI: 0.25-0.55), 201-350 (HR=0.18, 95% CI: 0.11-0.27), above 350 (HR=0.05, 95% CI: 0.02-0.07), body weight 45-60 kg (HR=0.75, 95% CI: 0.59-0.94), weight above 60 kg (HR=0.53, 95% CI: 0.39-0.72), widowed (HR=0.49, 95% CI: 0.36-0.67), and residing outside Zoba Maekel (HR=0.53, 95% CI: 0.34-0.82) were predictors of good survival.

Conclusion: The mortality rate is relatively low. PLHIV who started ART above 45 years, bedridden and ambulatory, and those with poor adherence were more likely to have lower survival. HIV/AIDS control programs and other stakeholders are strongly recommended to strengthen community awareness of the importance of early testing, immediate initiation of ART, regular follow-up and treatment adherence.