Comparison of home and hospital deaths among patients on anti-retroviral therapy (ART): A clinical and verbal autopsy study

Abstract

AimTo identify factors associated with home and hospital deaths among human immunodeficiency virus (HIV) infected adult patients in Nigeria. BackgroundCauses of mortality among HIV infected hospitalized patients on anti-retroviral therapy (ART) have been characterized in sub-Saharan Africa. However, majority of deaths occur outside hospitals. Materials and methodsWe undertook a retrospective clinical review on patients who were on ART and died at home or in the hospital. We obtained additional information on those who died at home through verbal autopsy and qualitative interview by our Home Based Care Team (HBCT). ResultsA total of 101 patient deaths over three years were reviewed. Those who died at home (51) or hospital (50) had similar ages, gender, co-morbidities, proportions with stages III/IV disease and opportunistic diseases. The median pre-ART CD4 cell counts for those who died at home and hospital was 108cells/μl and 72.0cells/μl respectively and they had been on similar ART regimens. Adherence was less 14/51 (27.5%) versus 30/50 (60%) (p=0.040) and use of traditional medicines (TM) higher 41/51 (80.4%) versus 16/50 (32%) (p=0.014) among those who died at home. Tuberculosis (TB) was the commonest cause of death accounting for 33/51 (64.7%) and 31/50 (62.0%) (p=0.979) of the home and hospital deaths respectively. Verbal autopsy and qualitative interview also identified TB, poor adherence, ART drug resistance and side effects as well as poverty, stigma, use of TM and spiritual alternatives as important causes of deaths. Tuberculosis is the overall cause of death. ConclusionStrategies for improving adherence, prevention and treatment of TB should be explored.