Survival and predictors of mortality among people living with HIV (PLHIV) on antiretroviral therapy in Ethiopia (2016-2023): a retrospective cohort study.
Minilik Demissie Amogne, Abeje Kebede, Derbachew Asfaw, Getahun Fetensa, Feyissa Lemessa, Kidist Zealiyas, Wudinesh Belete Belihu, Wegene Tamene, et al. (23 authors)
BMJ open · 2026-03
Abstract
OBJECTIVE: Despite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of 'test and treat' remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023.
DESIGN: We conducted a retrospective open cohort study.
SETTING: 65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p<0.05.
PARTICIPANTS: The analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was survival status at the end of follow-up, defined as death versus alive.
RESULT: Among 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85 972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (≥35 years), bedridden (AHR 2.46, 95% CI 1.78 to 3.40) and ambulatory status (AHR 2.33, 95% CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95% CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95% CI 1.13 to 1.76) and baseline CD4 <200 cells/mm³ (AHR 3.08, 95% CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95% CI 0.30 to 0.43).
CONCLUSION: The results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.
MeSH terms
- Humans
- Ethiopia
- HIV Infections
- Retrospective Studies
- Male
- Female
- Adult
- Middle Aged
- Kaplan-Meier Estimate
- Proportional Hazards Models
- Anti-HIV Agents
- Young Adult
- Survival Rate
- Anti-Retroviral Agents
- CD4 Lymphocyte Count
- Risk Factors