Risk factors for early mortality among HIV-positive adults on antiretroviral therapy in Ethiopian health facilities

The rapid expansion of antiretroviral therapy (ART) in Ethiopia has significantly reduced AIDS-related deaths; however, survival rates among people living with HIV (PLHIV) on ART remain variable, and findings on predictors of early mortality are inconsistent. This study aimed to identify factors associated with early mortality among ART users in the Woliso district of Ethiopia. A historical cohort study was conducted among 720 randomly selected ART users from January 2018 to December 2022. Data were collected using Open Data Kit (ODK) and analyzed with STATA 13. Kaplan-Meier survival analysis and Cox proportional hazards regression were employed to assess predictors of mortality. The mortality incidence density was 5.1 per 100 person-years (95% CI: 4.01-6.50). Significant predictors of early mortality included being divorced (AHR: 6.34; 95% CI: 2.05-19.65), advanced WHO clinical stage III/IV (AHR: 2.92; 95% CI: 1.12-8.27), and suboptimal ART adherence-fair (AHR: 5.48; 95% CI: 2.37-12.66) and poor (AHR: 3.50; 95% CI: 1.72-7.09). This study highlights a high early mortality rate, emphasizing the need for early HIV care enrollment and strict treatment adherence to improve survival. Strengthening ART programs with targeted interventions for high-risk groups, such as divorced individuals and those with advanced disease, could further reduce mortality in Ethiopia.