Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study
Abstract Background Despite global efforts to improve HIV care, late diagnosis and delayed antiretroviral therapy (ART) initiation continue to pose mortality risks among people living with HIV (PLHIV) with advanced HIV disease (AHD). This study investigated factors associated with mortality among PL...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-025-11397-1 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849767528435286016 |
|---|---|
| author | Kabali Bwogi Catherine Nassozi Lwanira Ivan Kasamba Joseph Baruch Baluku Justine K. Nakiwala Regina Ndagire Catherine Nassolo Gerald Wabomba Christopher Bwanika Jane Nakawesi Grace Namayanja Joseph Kabanda Julius N. Kalamya Julius Ssempiira Catherine Ssenyimba Ronald Mulebeke Arthur G. Fitzmaurice Barbara Mukasa |
| author_facet | Kabali Bwogi Catherine Nassozi Lwanira Ivan Kasamba Joseph Baruch Baluku Justine K. Nakiwala Regina Ndagire Catherine Nassolo Gerald Wabomba Christopher Bwanika Jane Nakawesi Grace Namayanja Joseph Kabanda Julius N. Kalamya Julius Ssempiira Catherine Ssenyimba Ronald Mulebeke Arthur G. Fitzmaurice Barbara Mukasa |
| author_sort | Kabali Bwogi |
| collection | DOAJ |
| description | Abstract Background Despite global efforts to improve HIV care, late diagnosis and delayed antiretroviral therapy (ART) initiation continue to pose mortality risks among people living with HIV (PLHIV) with advanced HIV disease (AHD). This study investigated factors associated with mortality among PLHIV with AHD in rural North-Central Uganda from January 2018 to December 2021. Methods We retrospectively reviewed electronic medical records from 18 health facilities, collecting data on demographics and clinical characteristics, including baseline CD4 count, ART regimen, BMI, TB status, TPT use, WHO clinical stage, and viral load. AHD was defined as a baseline CD4 < 200 cells/mm³. Cox proportional hazards modeling identified mortality-associated factors, reported as adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a 5% significance level. Results We analyzed 1161 PLHIV with AHD, contributing 1565.6 person-years. There were 84 deaths (7.2%), yielding a mortality rate of 5.4 per 100 person-years (95% CI: 4.33–6.64). Mortality was significantly associated with age ≥ 50 years (aHR 4.16 [1.77–9.77]), no viral load test (aHR 16.23 [7.44–35.39]), viral load non-suppression (aHR 9.05 [3.37–24.29]), CD4 ≤ 50 (aHR 1.91 [1.08–3.39]), no TB prophylaxis (aHR 3.51 [1.83–6.74]), and WHO stage 3 or 4 (aHR 1.91 [1.12–3.27]). Conclusion Despite advances in HIV programs, the mortality rate among patients with AHD highlights ongoing challenges. Early identification of AHD patients, regular viral load testing, optimizing ART and ensuring adherence, along with promoting tuberculosis preventive therapy, could help reduce mortality, improve patient outcomes, and achieve HIV epidemic control by 2030. |
| format | Article |
| id | doaj-art-402d86e1f26249dca3ebed38f2366d56 |
| institution | DOAJ |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-402d86e1f26249dca3ebed38f2366d562025-08-20T03:04:10ZengBMCBMC Infectious Diseases1471-23342025-08-0125111310.1186/s12879-025-11397-1Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective studyKabali Bwogi0Catherine Nassozi Lwanira1Ivan Kasamba2Joseph Baruch Baluku3Justine K. Nakiwala4Regina Ndagire5Catherine Nassolo6Gerald Wabomba7Christopher Bwanika8Jane Nakawesi9Grace Namayanja10Joseph Kabanda11Julius N. Kalamya12Julius Ssempiira13Catherine Ssenyimba14Ronald Mulebeke15Arthur G. Fitzmaurice16Barbara Mukasa17Mildmay UgandaDepartment of Research, School of Graduate Studies, Research and Innovations, Clarke International UniversityMildmay UgandaMildmay UgandaMildmay UgandaDepartment of Research, School of Graduate Studies, Research and Innovations, Clarke International UniversityMildmay UgandaMildmay UgandaMildmay UgandaMildmay UgandaDivision of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC)Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC)Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC)Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC)Mildmay UgandaMildmay UgandaDivision of Global HIV and TB, U.S. Centers for Disease Control and Prevention (CDC)Mildmay UgandaAbstract Background Despite global efforts to improve HIV care, late diagnosis and delayed antiretroviral therapy (ART) initiation continue to pose mortality risks among people living with HIV (PLHIV) with advanced HIV disease (AHD). This study investigated factors associated with mortality among PLHIV with AHD in rural North-Central Uganda from January 2018 to December 2021. Methods We retrospectively reviewed electronic medical records from 18 health facilities, collecting data on demographics and clinical characteristics, including baseline CD4 count, ART regimen, BMI, TB status, TPT use, WHO clinical stage, and viral load. AHD was defined as a baseline CD4 < 200 cells/mm³. Cox proportional hazards modeling identified mortality-associated factors, reported as adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a 5% significance level. Results We analyzed 1161 PLHIV with AHD, contributing 1565.6 person-years. There were 84 deaths (7.2%), yielding a mortality rate of 5.4 per 100 person-years (95% CI: 4.33–6.64). Mortality was significantly associated with age ≥ 50 years (aHR 4.16 [1.77–9.77]), no viral load test (aHR 16.23 [7.44–35.39]), viral load non-suppression (aHR 9.05 [3.37–24.29]), CD4 ≤ 50 (aHR 1.91 [1.08–3.39]), no TB prophylaxis (aHR 3.51 [1.83–6.74]), and WHO stage 3 or 4 (aHR 1.91 [1.12–3.27]). Conclusion Despite advances in HIV programs, the mortality rate among patients with AHD highlights ongoing challenges. Early identification of AHD patients, regular viral load testing, optimizing ART and ensuring adherence, along with promoting tuberculosis preventive therapy, could help reduce mortality, improve patient outcomes, and achieve HIV epidemic control by 2030.https://doi.org/10.1186/s12879-025-11397-1MortalityAdvanced HIV diseaseViral loadTuberculosis preventive therapy |
| spellingShingle | Kabali Bwogi Catherine Nassozi Lwanira Ivan Kasamba Joseph Baruch Baluku Justine K. Nakiwala Regina Ndagire Catherine Nassolo Gerald Wabomba Christopher Bwanika Jane Nakawesi Grace Namayanja Joseph Kabanda Julius N. Kalamya Julius Ssempiira Catherine Ssenyimba Ronald Mulebeke Arthur G. Fitzmaurice Barbara Mukasa Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study BMC Infectious Diseases Mortality Advanced HIV disease Viral load Tuberculosis preventive therapy |
| title | Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study |
| title_full | Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study |
| title_fullStr | Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study |
| title_full_unstemmed | Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study |
| title_short | Factors associated with mortality among people with advanced HIV disease in rural uganda: a retrospective study |
| title_sort | factors associated with mortality among people with advanced hiv disease in rural uganda a retrospective study |
| topic | Mortality Advanced HIV disease Viral load Tuberculosis preventive therapy |
| url | https://doi.org/10.1186/s12879-025-11397-1 |
| work_keys_str_mv | AT kabalibwogi factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT catherinenassozilwanira factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT ivankasamba factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT josephbaruchbaluku factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT justineknakiwala factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT reginandagire factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT catherinenassolo factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT geraldwabomba factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT christopherbwanika factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT janenakawesi factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT gracenamayanja factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT josephkabanda factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT juliusnkalamya factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT juliusssempiira factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT catherinessenyimba factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT ronaldmulebeke factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT arthurgfitzmaurice factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy AT barbaramukasa factorsassociatedwithmortalityamongpeoplewithadvancedhivdiseaseinruralugandaaretrospectivestudy |