Abstract:

Introduction: HIV is still a global problem causing high mortality compared to general population even with the use of HAART. The literature on the magnitude of this problem is still scare in our country especially in rural setting of HIV care and treatment. The aim of this study was to determine the prevalence and baseline risk factors of mortality among HIV patients receiving HAART at care and treatment services in a rural setting of northwestern Tanzania.

Methods: This was cross sectional cohort study involving HIV patients started on ART between January 2008 and December 2015 at Sengerema CTC in Mwanza Tanzania. A systematic sampling was done to obtain the sample size and data on age, date of HIV diagnosis, WHO clinical stage, OIs, baseline CD4, FBP, HAART regimen, time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11.

Results: In total 740 patients were included for analysis. The median age of the participants was 35 (27-42) years with a female predominance of 465 (62.84%). More a third 261 (35.27%) of participants had WHO stage 3&4 diseases with TB being the most common 197 (26.62%). Most participants 258 (34.86%) had baseline CD4<200cells/µl and 288 (38.92%) were anemic with a median HB of 11.4 (9.7-13.1) g/dL. Of the study participants 86 (11.62%) died, with most death (67.4%) occurring in the first years of HAART. The mortality was independently associated with male gender (16% vs. 9%, p=0.015), being divorced (OR=2.7, p<0.001), WHO stage 3&4 (OR=2.3, p=0.05), baseline CD4 <2000 cells/µl (OR=3.4, p<0.001) and severe anemia (OR=6.6, p<0.001).

Conclusions: The mortality is still high among HIV patients receiving HAART in north western rural Tanzania. Universal testing could increase early diagnosis before HIV is adversely advanced. A close clinical follow up of those at risk patients within the first year of HAART could serve as a potential strategy to reduce the mortality of this sub group of patients.