Survival Of Persons On Haart In Coptic Hospital, Nairobi, Kenya

Abstract

Background: Variations in survival rates between males and females initiated on High antiretroviral therapy (HAART) have been reported in many HIV intervention programs and studies that show evidence of increasing mortality in males compared to females. It is desirable and of greater interest to have estimates of expected survival rates of both males and females living with HIV/AIDS. The indicators of variation that yield the difference in survival are considered important in: future disease estimates in numbers and projections; generate interest in further study on the science of HIV/AIDS; review of curative and treatment mechanisms; modelling of the disease and other infections; progressive monitoring of the epidemic and making informed decisions on health, healthcare workers and interventions at all levels of healthcare delivery. This study presents survival comparisons between males and females enrolled at the same time and observed until the end of the study. It also identifies some of the factors influencing survival of persons in HAART by gender and presents the determined survival rates of HIV-infected patients treated with HAART. It is expected that this contribute to improve health outcomes in different population settings. Objective: To assess the survival of persons starting HAART with the aim of determining demographic gender characteristics and survival probabilities. Design A longitudinal study of HIV/AIDS persons on HAART. Main study Variables: The main study variables are both demographic and clinical. The demographic data variables are age, gender, marital status, occupation, level of formal education, region the person is coming from (place of residence) and monthly income. Clinical data are; whether the patient is on ART, calendar year of ART initiation, first date of clinic visit, last date of clinic visit, and mortality date. Study population: Persons on follow up and starting HAART in a HIV/ AIDS care facility in Nairobi, Kenya. Survival of Persons Starting HAART in Coptic Hospital, Kenya 2 | P a g e Results: The study was conducted from 2006 to 2011 and enrolled 2453 participants; 62% female and 38% males. Mean, median and standard deviation of their ages were 33.17, 33.00 and 10.144 years respectively. At the end of the five-year with 3-month interval visits within the study period, it was observed that more men than women (adjusted hazard ratio, 1.19, 95%; CI 1.14 – 1.27)on HAART were identified to be missing appointments and thereby needing follow ups. After adjusting for covariates at mean levels, survival and hazard functions curves showed higher survival probabilities for females compared to males and higher hazard probabilities for males compared to females. The factors that contributed significantly to the differences in mortality are levels of education, occupation and marital status of persons under study. Despite the fact that most of the data elements had no responses from the study participants, mean covariates had within - significance to the survival rates. Conclusion: Variation in mortality rates of males and females on HAART can be attributed to differences in response to treatment. Future studies should be undertaken to determine whether the gender difference in survival rates are wholly or partly to this factor and/or Lost-to-follow-up of target study participants.