Mortality Over Long-term Follow-up for People With HIV Receiving Longitudinal Care and Antiretroviral Therapy in Rural Haiti

Background Deaths from HIV have fallen dramatically with the increasing availability of fully suppressive antiretroviral therapy (ART), and yet HIV remains the ninth leading cause of death in low-income countries. As more people with HIV enter care and receive ART, the focus will need to shift from expanding ART to including long-term program effectiveness and outcomes for people with HIV already engaged in care. Methods We evaluated risk factors for mortality among people with HIV on ART receiving longitudinal care in rural Haiti. We assessed baseline characteristics using a household survey and abstracted clinical characteristics from the electronic record. We used multivariable Cox regression models to identify risk factors for mortality. Results There were 464 people included in this study with a median follow-up (interquartile range [IQR]) of 69 (44–77) months, during which time 37 (8%) were lost to follow-up and 118 (25%) died (median time to death [IQR], 29 [12–53] months). After adjustment, poverty (adjusted hazard ratio [AHR], 1.12 per 10–percentage point increased probability; 95% CI, 1.01–1.24) and single marital status (AHR, 1.59; 95% CI, 1.08–2.36) were associated with increased mortality. Age (AHR, 0.78 per 10-year increase; 95% CI, 0.64–0.94), role function quality of life (AHR, 0.75 per quintile increase; 95% CI, 0.62–0.90), and CD4 count (AHR, 0.66 per 100 cells/μL; 95% CI, 0.58–0.75) were associated with decreased mortality. Conclusions Poverty, marital status, and quality of life were associated with mortality. Social protection should be evaluated as a strategy to reduce mortality for people with HIV in concert with increasing access to ART.