Causes of death in people living with HIV: Lessons from five health facilities in Eswatini.

Southern African journal of HIV medicine Pub Date : 2024-10-28 eCollection Date: 2024-01-01 DOI:10.4102/sajhivmed.v25i1.1614
Yves Mafulu, Sukoluhle Khumalo, Victor Williams, Sandile Ndabezitha, Elisha Nyandoro, Nkosana Ndlovu, Alexander Kay, Khetsiwe Maseko, Hlobsile Simelane, Siphesihle Gwebu, Normusa Musarapasi, Arnold Mafukidze, Pido Bongomin, Nduduzo Dube, Lydia Buzaalirwa, Nkululeko Dube, Samson Haumba
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Abstract

Background: Eswatini has a high HIV prevalence in adults and, despite being one of the first countries to achieve the UNAIDS 95-95-95 targets, AIDS-related deaths are still high.

Objectives: This study describes the causes of death among people living with HIV (PLHIV) receiving care at five clinics in Eswatini.

Method: A cross-sectional review of sociodemographic, clinical and mortality data of deceased clients who received care from 01 January 2021 to 30 June 2022, was conducted. Data were extracted from the deceased clients' clinical records, and descriptive and comparative analysis was performed.

Results: Of 257 clients, 52.5% (n = 135) were male, and the median age was 47 years (interquartile range [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%). Clients who had been on antiretroviral therapy (ART) for 12-60 months (OR: 0.01; 95% confidence interval [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. Clients aged ≥ 40 years had higher odds of dying from COVID-19, while female clients (OR: 2.64; 95% CI: 1.29, 5.70) had higher odds of death from malignancy.

Conclusion: Most clients who died were aged 40 years and above and died from NCD-related causes, indicating a need to integrate prevention, screening, and treatment of NCDs into HIV services. Specific interventions targeting younger PLHIV will limit their risk for AHD.

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艾滋病毒感染者的死亡原因:埃斯瓦提尼五个医疗机构的经验教训。
背景:埃斯瓦提尼的成人艾滋病感染率很高,尽管该国是最早实现联合国艾滋病规划署 95-95-95 目标的国家之一,但与艾滋病相关的死亡人数仍然居高不下:本研究描述了在埃斯瓦提尼五个诊所接受治疗的艾滋病病毒感染者(PLHIV)的死亡原因:方法:对 2021 年 1 月 1 日至 2022 年 6 月 30 日期间接受治疗的已故患者的社会人口学、临床和死亡率数据进行横断面回顾。数据提取自死亡患者的临床记录,并进行了描述性分析和比较分析:在257名患者中,52.5%(n = 135)为男性,年龄中位数为47岁(四分位距[IQR]:38-59)。主要死因是非传染性疾病(NCDs)(n = 59,23.0%)、恶性肿瘤(n = 37,14.4%)、COVID-19(n = 36,14.0%)和晚期艾滋病(AHD)(n = 24,9.3%)。接受抗逆转录病毒疗法(ART)12-60 个月(OR:0.01;95% 置信区间[CI]:0.0006, 0.06)和大于 60 个月(OR:0.006;95% 置信区间[CI]:0.0003, 0.029)的患者与接受抗逆转录病毒疗法小于 12 个月的患者相比,死于 AHD 的几率较低。年龄≥40岁的患者死于COVID-19的几率更高,而女性患者死于恶性肿瘤的几率更高(OR:2.64;95% CI:1.29,5.70):大多数死亡者年龄在 40 岁及以上,死于非传染性疾病相关原因,这表明有必要将非传染性疾病的预防、筛查和治疗纳入艾滋病服务。针对年轻艾滋病感染者的特定干预措施将降低他们罹患艾滋病的风险。
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Causes of death in people living with HIV: Lessons from five health facilities in Eswatini. Southern African HIV Clinicians Society guideline on the management of non-tuberculous mycobacteria in people with HIV. Economic impact of extending reflexed cryptococcal antigenaemia CD4 threshold in South Africa. Condomless anal intercourse among HIV-positive and HIV-negative men who have sex with men in Zimbabwe. Beliefs affecting ART adherence in newly diagnosed HIV-positive participants in Manzini, Eswatini.
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