A study examining data from records at facilities serving more than 160,000 patients on treatment for HIV across Zambia, along with data tracking patients who stopped coming for care at the facilities found that 7 percent of all patients treatment died within two years, a figure from three-to-nine times higher than previous estimates. Those findings mean that death rates among HIV patients on treatment in Zambia are from 10-to-20 times higher than among patients on treatment in Europe, write the authors of the study, published on PLOS Medicine Thursday. More than 95 percent of the deaths were attributed to illness, rather than traffic accidents, childbirth or other causes of death that also can be higher in African countries than in Europe.
The findings indicate gaps, at some facilities more than others, in medical services that include diagnostic capacities and advanced care, the authors write. Patients treated at hospitals survived in greater numbers, as did patients being treated in settings outside of cities. While the most deaths occurred during the first few months of treatment, death rates remained high over longer periods. Death rates varied widely across facilities, indicating a need to focus on improving HIV services at site level. At a time when efforts to widen access to antiretroviral treatment include lessening the frequency of clinic visits and shifting responsibility for some HIV services from doctors to nurses and other health workers, the findings indicate the need to identify patients who need greater levels and frequency of care.
The study, conducted by the Centre for Infectious Disease Research in Zambia — CIDRZ — with the Zambia Ministry of Health, was led by Dr. Charles Holmes of Georgetown University Medical Center’s Center for Global Health and Quality, and Izukanji Sikazwe of CIDRZ.