Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo

Roger T. Buju, Pierre Z. Akilimali (), Nguyen-Toan Tran, Erick N. Kamangu, Gauthier K. Mesia, Jean Marie N. Kayembe and Hippolyte N. Situakibanza
Additional contact information
Roger T. Buju: Department of Public Health, Faculty of Medicine, University of Bunia, Bunia P.O. Box 292, Congo
Pierre Z. Akilimali: Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
Nguyen-Toan Tran: Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Sydney, NSW 2007, Australia
Erick N. Kamangu: Département des Sciences de Base, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
Gauthier K. Mesia: Unité de Pharmacologie Clinique et Pharmacovigilance, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
Jean Marie N. Kayembe: Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
Hippolyte N. Situakibanza: Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo

IJERPH, 2022, vol. 19, issue 16, 1-10

Abstract: This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan–Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78–20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women’s inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.

Keywords: armed conflict; antiretroviral therapy; survival analysis; Bunia; Republic Democratic of Congo (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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