Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda

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Burkey, Matthew D. MD, MPH; Weiser, Sheri D. MD, MA, MPH; Fehmie, Desiree MPH, MSc; Alamo-Talisuna, Stella MD, PhD; Sunday, Pamella MS; Nannyunja, Joy; Reynolds, Steven J. MD; Chang, Larry W. MD, MPH

Published Ahead-of-Print
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Abstract

Objective: To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda.
Design: Retrospective cohort study nested in an antiretroviral clinic-based cohort.
Methods: SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005-2009.
Results: Among 1763 adults (70.5% female; mean age 36.2 years (SD=8.4)) enrolled in ART, 14.4% (n=253) were confirmed dead and 19.7% (n=346) were LTFU at 4-year follow-up. No formal education (Adjusted Odds Ratio (AOR) 1.76; 95% Confidence Interval (CI): 1.19 to 2.59), having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66) and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LFTU at 4 years.
Conclusions: Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index, may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.
(C) 2013 by Lippincott Williams & Wilkins

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