Mortality rates and their determinants.

Background
The human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs.
Methods
A retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk.
Results
The cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality.
Conclusion
Survival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.

背景
人类免疫缺陷病毒（human immunodeficiency virus, HIV）自20世纪70年代初以来已造成极大公共卫生危害，全球累计感染人数达3760万。加纳于2015年采用90-90-90治疗策略，其总体目标为到2030年终结HIV新发感染，并提升HIV血清阳性个体的预期寿命。随着高效抗逆转录病毒疗法（Highly Active Antiretroviral Therapy）的规模化推广，接受抗逆转录病毒治疗的艾滋病病毒感染者（People Living with HIV, PLWH）的预期寿命有望得到改善。然而在加纳的农村地区，目前对接受抗逆转录病毒药物（antiretrovirals, ARVs）治疗的艾滋病病毒感染者的生存概率仍知之甚少。因此本研究旨在评估接受抗逆转录病毒治疗的艾滋病病毒感染者的生存趋势。

方法
本研究对2016年至2020年间，加纳塔莱（Tatale）与扎布祖古（Zabzugu）地区各抗逆转录病毒治疗中心收集的接受抗逆转录病毒治疗的艾滋病病毒感染者数据开展回顾性评估。本研究共纳入261名受试者，采用Stata 16.0统计软件进行数据分析。通过寿命表分析法与Kaplan-Meier图（Kaplan-Meier graph）评估生存概率，采用“Stptime”指标（每1000人年）及竞争风险回归模型评估死亡率与死亡风险。

结果
本研究中受试者的累计生存概率为0.8847（95%置信区间：0.8334~0.9209）；总死亡率为51.89（95%置信区间：36.89~72.97）每1000人年。分析显示，WHO临床分期Ⅲ、Ⅳ期[调整后风险比（adjusted hazard ratio, AHR）：4.25，95%CI：1.6~9.71，p=0.001]以及50岁及以上年龄组[AHR：5.02，95%CI：1.78~14.13，p=0.002]与死亡率显著相关。

结论
塔莱与扎布祖古地区的艾滋病病毒感染者群体整体生存概率较高，死亡率呈下降趋势。临床医师应重点关注并照护处于WHO HIV分期Ⅲ、Ⅳ期的患者，同时强化所有就诊环节的HIV筛查，因早期诊断与更高的生存概率密切相关。