{
  "abstract": "Objective Despite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of ‘test and treat’ remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023.Design We conducted a retrospective open cohort study.Setting 65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p<0.05.Participants The analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment.Primary and secondary outcome measures The primary outcome was survival status at the end of follow-up, defined as death versus alive.Result Among 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85 972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (≥35 years), bedridden (AHR 2.46, 95% CI 1.78 to 3.40) and ambulatory status (AHR 2.33, 95% CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95% CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95% CI 1.13 to 1.76) and baseline CD4 <200 cells/mm³ (AHR 3.08, 95% CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95% CI 0.30 to 0.43).Conclusion The results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.",
  "authors": [
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Minilik Demissie Amogne"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Abeje Kebede"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Derbachew Asfaw"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Getahun Fetensa"
    },
    {
      "affiliations": [
        "St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia"
      ],
      "name": "Feyissa Lemessa"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Kidist Zealiyas"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Wudinesh Belete Belihu"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Wegene Tamene"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Gemechu Gudeta"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Feyiso Bati Wariso"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Getnet Hailu"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Amelework Yilma Shiferaw"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Lemessa Debel"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Worku Dechassa"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Bira Bejiga"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Kiflu Itefa"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Belete Woldesemayat Hailemariam"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Abebe Habtesilase"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Dereje Yenealem"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Tariku Tesfaye Bekuma"
    },
    {
      "affiliations": [
        "HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Jaleta Bulti"
    },
    {
      "affiliations": [
        "Deputy director general, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Getachew Tollera"
    },
    {
      "affiliations": [
        "Infectious Disease Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Gemechu Tadesse"
    }
  ],
  "title": "Survival and predictors of mortality among people living with HIV (PLHIV) on antiretroviral therapy in Ethiopia (2016–2023): a retrospective cohort study",
  "uid": "b7d07b45-1671-5af4-9a55-01b8239aee4b"
}