This study assessed the effects of UTT program in comparison with the differed program on survival status and treatment outcomes of HIV infected patients initiated ART treatment in health facilities of Gurage zone. The incidence of death was significantly higher in the differed (CD4 based) program than the UTT program. It may be due to the fact that patients during the differed program commonly present with late WHO clinical stages or after developing serious opportunistic infection [2,3,4,5,6]. Similarly, the immune response depends on CD4 level, so that; patients in the differed program may not have good response to treatment [5].
Patients in the UTT survived for longer period of time than patients enrolled in the differed treatment program. As the universal test and treat program makes patients to get medical support in the early stages of infection the response to treatment will be obviously better [7,8,9]. Meanwhile, early treatment and prophylaxis prevents the development of fatal opportunistic infections. So that the survival of patients in the test and treat program is longer [2, 3]. Also previous studies reported that early presentation and medical care increases the survival of patients [14,15,16,17,18]. It has to be noted that patients who were enrolled under differed program were not followed until their CD4 count or WHO stage make them eligible to be enrolled for treatment. However patients on UTT program were enrolled for treatment soon after diagnosis, hence these time lapses between diagnosis and enrolment for treatment would have an impact on survival time differences.
The probability of survival at the end of 2 years of follow up is higher than the findings of previous studies conducted elsewhere [15, 17,18,19]. This is due to the effect of the universal test and treat program included in our study, which increases the survival of patients [16, 19]. On the other hand, the cumulative incidence of mortality was significantly higher among patients enrolled in differed treatment programs compared to patients enrolled in UTT program. This can be explained by increased risk of opportunistic infections, treatment failure and drug side effects which are more common in the differed treatment arm [15,16,17,18].
During the follow up period 48 (9.6%) patients died. Lower rate of death was observed in the UTT cohort. The proportion of death in our case is lower than many other studies [17, 20, 28]. There are also other recent researches that have reported a lower AIDS related death rate in Ethiopia [29,30,31,32]. This could be partly attributed to the effects of UTT program implementation in Ethiopia.
Change in treatment regimen, patient condition during admission, program organization, residence and multitude of other factors significantly contribute for the difference in survival rate. With all this benefits early initiation of treatment with UTT program reduced mortality [17, 28]. Generally, in Ethiopia it was noted from WHO reports and previous studies that the success rate was higher in both of HIV treatment programs but more positive outcomes are found on UTT program [1, 2, 28].
In line with finding of this study, many other model based researches have reported that UTT program will reduce mortality [16, 17, 31]. We hazard of death in CD4 based enrolled individuals was 4 times higher than those who enrolled in UTT program. This is in line with other studies [25,26,27, 33]. This could be due to the fact that UTT program clients are enrolled for treatment soon after diagnosis when many of them are at higher CD4 count and better overall health conditions [17, 26]. This could result in low prevalence of co-infection, low probability of drug interaction and side effects and overall better compliance. Owing to the aforementioned positive attributes of UTT program the hazard of mortality has reduced.
Patients living in rural setups were two and half times more likely to die than urban resident patients. This may be due to better drug adherence, accessibility of service, and knowledge difference. Likewise, patients who have developed treatment failure were four times more likely to die than their counter parts. In many researches it was reported that treatment failure is a strong marker of mortality while up on treatment [3, 15, 17]. This may be due to increased viral load and development of secondary infections [22, 33].
Similarly, the risk of death in patients who developed new OIs was 3.66 (95% CI [2.4–5.6], p value < 0.001) times higher than those who did not develop new OIs. Also the increment of base line CD4 count by one unit reduces the probability of death by 0.4%. On the other hand the likely hood of mortality was increased by 5% as age increased by a year.