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Objective: To determine morbidity and mortality trends in people on ART attending Kilimanjaro Christian Medical Centre Care and Treatment Clinic from 2005 to 2011.
Methods: Since 2005 data for 5126 HIV/AIDS patients have been recorded at KCMC CTC. For the purpose of this report we analysed information recorded from 2005 to 2011. All patients’ data were used for morbidity analysis. A total of 1657 patients with age equal or greater than 15 years on ART and at least had visited CTC twice, whose data were used for mortality analysis. We calculated number and proportion of morbidity episodes per person and total person-years at risk. Then number of morbidities divided by total person-years at risk to get morbidity rates. We compared these rates between groups by log rank test. We used Poisson regression analysis to calculate the incidence relative risks for the morbidity episodes. For mortality data analysis, we calculated number of deaths and total person-years at risk. Then number of number of deaths divided by total person-years at risk to get mortality rates. We compared these rates between groups by log rank test. Survival estimates were performed by Kaplan-Meier methods to calculate and plot the curves for probabilities of patients surviving up to 6 years after ART initiation. We used Cox regression models to calculate the hazard ratios for mortality.
Results: Overall diarrhea morbidity rate was 2.9 per 1000 person-years at risk, 95% CI (1.87, 4.61). Diarrheal rate was highest, 7.1 per 1000 person-years at risk, 95% CI (3.56, 14.24) in patients on ART between 0 to 6 months post initiation and lowest, 1.8 per 1000 person-years at risk, 95% CI (0.91, 3.62) after more than 1 year post ART initiation. There appears a trend in morbidity reduction, although the log rank test for equality of rates between times on ART was not statistically significant (p>0.1). The overall mortality rate was 17.1 per 1000 person years at risk, 95 % CI (13.61, 21.47). During first 6 months, the mortality rate was 35.9 per 1000 person years at risk, 95 % CI (24.2, 53.1). Beyond 1 year post ART initiation, the mortality rate dropped to 10.9 per 1000 person years at risk, 95 % CI (7.7, 15.3). The log rank test for equality of rates between times on ART was not statistically significant (p>0.1), although a trend in mortality reduction is seen.
Conclusion: HIV/AIDS associated mortality at KCMC has decreased to 1.7% following the free availability of ART in 2005 in Tanzania. Prior to ART becoming freely available, the inpatient mortality at KCMC for the known HIV-positives was high varying from 14.6% to 21.2% over 1997-2000. |
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