Abstract:
Background: Globally, about 630,000 (500,000–820,000) deaths occur annually
among people living with HIV (PLHIV). Advanced HIV disease (AHD) continues
to be an important contributor to HIV-related mortality in sub-Saharan Africa.
Despite a significant positive association with mortality, the prevalence and fac
tors that lead to AHD in Addis Ababa have not been studied well. Thus, this study
aimed at investigating the prevalence and contributing factors of AHD in Addis
Ababa, Ethiopia.
Methods: We conducted a facility-based cross-sectional study among PLHIV
attending Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Data were col
lected through an interviewer-administered questionnaire and abstraction of 414
sturdy participants’ medical records using Open Data Kit. In the current study,
AHD was defined using the objective criterion of a CD4 count < 200 cells/μL.
Analysis was done using SPSS version 28 for descriptive and analytic statistics,
and statistical significance was set at p < 0.05.
Results: The overall prevalence of AHD, as well as among ART-naive and ART
experienced individuals, was 29.7% (95% CI: 25.4–34.4%), 51.4% (95% CI: 34.4
68.1%), and 27.6% (95% CI: 23.1–32.4%), respectively. Very severe and severe AHD
accounts for 21.9% (95% CI: 15.0–30.3%) and 17.9% (95% CI: 11.5–25.8%) of the
study participants, respectively. Further analysis of the determinants revealed that
AHD was more likely to manifest in men (AOR of 2.41, 95% CI: 1.23–4.74); manual
and service workers such as daily laborers, drivers, cleaners, and security guards
(AOR of 2.75, 95% CI: 1.18–6.40); those with lower average monthly incomes of
5,001–10,000 birr (AOR of 3.27, 95% CI: 1.11–9.64) and less than 5,000 birr (AOR
of 4.14, 95% CI: 1.49–11.54); the malnourished individuals (AOR of 5.82, 95% CI:
1.97–17.18); and those non-adherent to ART (AOR of 9.88, 95% CI: 4.32–22.03).
Conclusion: The burden of AHD remains substantial, disproportionately affecting
ART-naïve individuals. Male sex, low monthly income, being a manual and service
worker, malnutrition, and ART non-adherence were key factors associated with
HIV progression. Implementing the WHO-recommended AHD package may help
reduce AHD and improve clinical outcome and ultimately death.
