BACKGROUND: AIDS-related deaths in Uganda declined rapidly between 2010 and 2020 following the rapid scale-up of antiretroviral therapy (ART) but the rate of decline has slowed over time, with no change in the estimated deaths between 2019 and 2020. Globally, tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). To gain a better understanding of causes of death among PLHIV in Uganda, we conducted an assessment to investigate factors associated with mortality.
METHODS: We purposefully selected 29 facilities from 13 regions to include regional referral hospitals and those with the highest number of deaths reported in DHIS2. We included PLHIV who had at least one documented clinic visit in 2021. Electronic medical records were used to identify deceased or lost clients. Healthcare workers called lost clients to determine if they were in care elsewhere or had since passed. Chart reviews were then conducted on all known deceased clients, extracting information including cause of death. Quantitative data derived from the data collection tools were exported from SurveyCTO and analyzed using MSExcel and StataSE 15.
RESULTS: In total, 899 health records were extracted, of which 846 were confirmed to be deceased and positive for HIV. Median age was 45, 52% were male, and mean weight was 55kgs. 619 had recorded CD4 tests, of which 41% were less than 200 copies/mL and 22% were above 500 copies/mL. 86% received cotrimoxazole at some point and 57% of eligible clients received TB preventive therapy (TPT). 32% had a cause of death recorded according to survey prepopulated categories; 35% listed ‘other’ cause and 33% ‘unknown’. Among the selected causes, TB had the highest proportion (42%), followed by cancer (17%), non-communicable diseases (11%), and cryptococcal meningitis (8%).
CONCLUSIONS: As it is globally, TB continues to be a leading cause of death amongst PLHIV in Uganda and increasing efforts to provide TPT may help to reduce this burden. Further investigation of the high proportion of ‘other’ and ‘unknown’ causes of death will additionally clarify drivers of mortality. Routinizing mortality audits could inform and improve evidence-based programming to further reduce AIDS-related deaths.

Download the e-Poster (PDF)