Temporal trends of early mortality and its risk factors in HIV-infected adults initiating antiretroviral therapy in Uganda

A decline in mortality rates during the first 12 months of antiretroviral therapy (ART) has been mainly linked to increased ART initiation at higher CD4 counts and at less advanced World Health Organization (WHO) clinical stages of HIV infection; however, the role of improved patient care has not been well studied. We estimated improvements in early mortality due to improved patient care. We conducted a retrospective cohort study of HIV-infected individuals ages 18 and older who initiated ART at the Mengo HIV Counseling and Home Care Clinic between 2006 and 2016. We conducted a mediation analysis using generalized structural equation models with inverse odds ratio weighting to estimate the natural direct and indirect effects of ART initiation time on early mortality. Among 6,847 patients, most were female (69%), with a median age of 32 (interquartile range [IQR] = 28–38), versus a median age of 38 (IQR = 32–45) for males. The median CD4 count at ART initiation increased from 142 cells/ul (95% confidence interval [CI] = 135–150) in 2006–2010 to 302 cells/ul (95% CI = 283–323) in 2015–2016 (p