Causes of death in people living with HIV in the post 95 -95 -95 era: Lessons from five AIDS Healthcare Foundation clinics in Eswatini

Author:

Mafulu Yves1,Khumalo Sukoluhle1,Williams Victor2,Ndabezitha Sandile3,Nyandoro Elisha2,Ndlovu Nkosana1,Kay Alexander3,Maseko Khetsiwe1,Simelane Hlobisile1,Gwebu Siphesihle1,Musarapasi Normusa2,Mafukidze Arnold2,Bongomin Pido2,Dube Nduduzo4,Buzaalirwa Lydia4,Dube Nkululeko1,Haumba Samson2

Affiliation:

1. AIDS Healthcare Foundation

2. Center for Global Health Practice and Impact, Georgetown University

3. Baylor College of Medicine Children's Foundation

4. AIDS Healthcare Foundation Africa Bureau

Abstract

Abstract

Background Eswatini has a high HIV prevalence in adults (24.8%), and despite achieving HIV epidemic control, AIDS-related deaths are still high at 200 per 100,000 population. This study, therefore, describes the causes of death among people living with HIV (PLHIV) receiving care at five clinics in Eswatini. Methods Data of clients receiving antiretroviral therapy (ART) from five AIDS Healthcare Foundation (AHF) Clinics in Eswatini who died was analysed to describe the causes of death. Clients' records were included if they received treatment from any of the five clinics from January 1, 2021, to June 30, 2022. Clients' sociodemographic, clinical, and specific cause of death data were extracted from their clinical records into an Excel spreadsheet for mortality reporting and audits. The different causes of death were categorised and descriptive, and comparative analysis was done using Stata 15 and R. Odds ratio significant at p<0.05 (with 95% confidence interval) to estimate the different associations between the client's characteristics and the four leading causes of death. Results Of 257 clients, 52.5% (n=135) were males, and the median age was 47 years (IQR: 38, 59). The leading causes of death were non-communicable diseases (NCDs) (n=59, 23.0%), malignancies (n=37, 14.4%), Covid-19 (n=36, 14.0%) and advanced HIV disease (AHD) (n=24, 9.3%). Patients aged ≥60 years (OR 0.08; 95% CI: 0.004, 0.44) had lower odds of death from AHD than ≥40 years, and those who had been on ART for 12 – 60 months (OR 0.01; 95% CI: 0.0006, 0.06) and >60 months (OR 0.006; 95% CI: 0.0003, 0.029) had lower odds of death from AHD compared to those on ART for <12 months. Patients aged ≥40 years had higher odds of dying from COVID-19, while females (OR 2.64; 95% CI: 1.29, 5.70) had higher odds of death from malignancy. Conclusion Most patients who died were aged 40 years and above and died from an NCD, malignancy, COVID-19 and AHD-related cause. This indicates a need to expandprevention, screening, and integration of treatment for NCDs and cancers into HIV services. Specific interventions targeting younger PLHIV will limit their risks for AHD.

Publisher

Research Square Platform LLC

Reference38 articles.

1. Joint United Nations AIDS Program, Eswatini. Country Factsheets 2022 [Internet]. [cited 2024 Feb 20]. https://www.unaids.org/en/regionscountries/countries/swaziland.

2. World Health Organization. HIV – Number of people dying from HIV-related causes [Internet]. Geneva: WHO. 2022 [cited 2024 Feb 20]. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-deaths-due-to-hiv-aids.

3. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort;Croxford S;Lancet Public Health,2017

4. Marcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, Infection HIV, et al. JAMA Netw Open. 2020;3(6):2000–16.

5. Deployment of convalescent plasma for the prevention and treatment of COVID-19;Bloch EM;J Clin Invest,2020

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