Survival Rate and Socio-Demographic Determinants of Mortality in Adult HIV/AIDS Patients on Anti-Retrovial Therapy (ART) in Myanmar: a Registry Based Retrospective Cohort Study 2005-2015

Abstract

Background: With increasing coverage of anti-retroviral therapy (ART) among people living with HIV/AIDS, their survival has been improved in recent years. However, the country is still facing a substantial number of AIDS related deaths. In response to this problem, this study assesses the survival rate of adult HIV-infected patients receiving ART and identifies the determinants of their mortality including socio-demographic factors to identify areas for improvements.

Methods: A registry-based retrospective cohort study was applied by reviewing records of patients receiving ART between June 1, 2005 and May 31, 2015 at the HIV-specialist hospital in Yangon, Myanmar. Time to death was the main outcome measure in the study and the outcome date was December 31, 2015. Life Table Analysis, the Kaplan- Meier method and the Cox proportional hazards model were used to estimate survival and to identify determinants of mortality. A total of 7995 patients were included in the analysis.

Results: The mean follow-up time of the sample was 34.57 (SD ± 30.14) months and the median survival time of the sample was longer than 127 months. Mortality rate was 3.95 deaths per 100-person-year of follow up period.  The cumulative probabilities of survival at 6 months, 1 year, 5 years and 10 years of receiving ART were 0.91, 0.90, 0.86 and 0.83 respectively. Among the six socio-demographic characteristics, age and sex of the HIV-infected patients on ART are associated with their mortality, i.e. age at the start of ART of ≥35 years (Adjusted Hazard Ratio =1.28) and male (Adjusted Hazard Ratio =1.24). No OI prophylaxis (Adjusted Hazard Ratio =4.63), <95% ART adherence (Adjusted Hazard Ratio =14.78), not changing ART regimen during the course (Adjusted Hazard Ratio =2.31), WHO clinical staging 3 and 4 (Adjusted Hazard Ratio =1.39), bedridden functional status (Adjusted Hazard Ratio =2.18) and baseline CD₄ count of <200/mm³ (Adjusted Hazard Ratio =1.66) were treatment and clinical factors associated with HIV mortality after adjusting other covariates.

Conclusion: The findings indicate that priority should be given to patients who have a high risk of mortality within six months after initiation of ART. The study provides information to policy makers and HIV/AIDS program implementers to plan and implement appropriate interventions for the improvement of survival of HIV/AIDS patients in Myanmar.