Time to death and its predictors among adults living with HIV receiving ART in Ethiopia applying proportional hazard model

Globally, more than 32.7 million AIDS-related deaths have occurred, and about 38 million people were living with HIV by the end of 2019, yet only half had access to ART. Despite Ethiopia's long-standing ART program, evidence on mortality and its predictors remains limited in the study area, creating an information gap for policymakers. This study aimed to assess time to death and its predictors among adults living with HIV on ART at public health facilities, Northeast Ethiopia. A retrospective follow-up study was used among 602 study participants selected by simple random sampling method from clients enrolled for ART from July 8, 2010 to July 7, 2020 in public health facilities of Kemise town. Descriptive statistics was used to describe cohort characteristics and Kaplan-Meier analysis to estimate survival probability. Bi-variable and multivariable Cox-regression analysis was used to identify predictors of mortality. Hazard ratios along with 95% confidence interval (CI) were estimated to measure the strength of the association. Level of statistical significance was declared at p-value ≤ 0.05. Among 602 ART naïve study cohort, 108 patients were died with cumulative incidence density of 4.14 (95% CI (3.43, 5.00) per 100 Person Year Observed (PYO). The predictors of mortality were rural residents [adjusted hazard ratio (AHR) = 1.51, 95% CI (1.01, 2.28)], not taking co-trimoxazole prophylactic therapy(CPT) [AHR = 4.52, 95% CI (2.83, 7.21)], having co-morbidities [AHR = 1.64, 95% CI (1.06-2.55)], Patients with opportunistic infections (OIs) [AHR = 4.45, 95% CI (2.07, 9.59)], bedridden functional status [AHR = 3.21, 95% CI (1.52, 6.77)], unsuppressed viral load [AHR = 2.45, 95% CI (1.17, 5.10)], TB co-infection[AHR = 3.91, 95% CI (1.89, 8.08)], baseline CD₄ count of ≤ 50 cell/mm³ [AHR = 2.87, 95% CI (1.28, 6.44)] and CD₄ count of 51-200 cell/mm³ [AHR = 2.12, 95% CI (1.06, 4.24)]. Patients with opportunistic infections, rural residents, bedridden functional status, CD₄ count of ≤ 50 cell/mm³ and 51-200 cell/mm³, TB co-infection, having comorbidities, not taking CPT and high viral load status had higher hazard of die from AIDS-related illnesses. Substantial efforts are required for the prevention, early identification, and treatment of opportunistic infections. Earlier ART initiation and expansion of services to rural areas are also highly recommended to reduce mortality among adults on ART.