Poor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Uganda

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dc.contributor.authorOkwir, Mark
dc.contributor.authorLink, Abigail
dc.contributor.authorOpio, Bosco
dc.contributor.authorOkello, Fred
dc.contributor.authorNakato, Ritah
dc.contributor.authorNabongo, Betty
dc.contributor.authorAlal, Jimmy
dc.contributor.authorRhein, Joshua
dc.contributor.authorMeya, David
dc.contributor.authorLiu, Yu
dc.contributor.authorBohjanen, Paul R
dc.date.accessioned2024-05-27T10:12:42Z
dc.date.available2024-05-27T10:12:42Z
dc.date.issued2024-05
dc.description.abstractCryptococcal meningitis (CM) remains a major cause of death among people living with HIV in rural sub-Saharan Africa. We previously reported that a CM diagnosis and treatment program (CM-DTP) improved hospital survival for CM patients in rural, northern Uganda. This study aimed to evaluate the impact on long-term survival. We conducted a retrospective study at Lira Regional Referral Hospital in Uganda evaluating long-term survival ([greater than or equal to]1 year) of CM patients diagnosed after CM-DTP initiation (February 2017-September 2021). We compared with a baseline historical group of CM patients before CM-DTP implementation (January 2015-February 2017). Using Cox proportional hazards models, we assessed time-to-death in these groups, adjusting for confounders. We identified 318 CM patients, 105 in the Historical Group, and 213 in the CM-DTP Group. The Historical Group had a higher 30-day mortality of 78.5% compared to 42.2% in the CM-DTP Group. The overall survival rate for the CM-DTP group at three years was 25.6%. Attendance at follow-up visits (HR:0.13, 95% CI: [0.03-0.53], p <0.001), ART adherence (HR:0.27, 95% CI: [0.10-0.71], p = 0.008), and fluconazole adherence: (HR:0.03, 95% CI: [0.01-0.13], p 50kg (HR:0.54, 95% CI: [0.35-0.84], p = 0.006), and performance of therapeutic lumbar punctures (HR:0.42, 95% CI: [0.24-0.71], p = 0.001), were associated with lower risk of death. Altered mentation was associated with increased death risk (HR: 1.63, 95% CI: 1.10-2.42, p = 0.016). Long-term survival of CM patients improved after the initiation of the CM-DTP. Despite this improved survival, long-term outcomes remained sub-optimal, suggesting that further work is needed to enhance long-term survival.en_US
dc.identifier.citationOkwir, Mark, Abigail Link, Bosco Opio, et al. 'Poor Long-Term Outcomes Despite Improved Hospital Survival for Patients with Cryptococcal Meningitis in Rural, Northern Uganda', PloS One, vol. 19/no. 5, (2024), pp. e0303805.en_US
dc.identifier.issnISSN 1932-6203
dc.identifier.issnEISSN 1932-6203
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/9536
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.subjectMedical risk factors; Antiretroviral therapy; HIV ; Death rates ; HIV diagnosis and management ; Long-term care; Hospitalizations; Virus testingen_US
dc.titlePoor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Ugandaen_US
dc.typeArticleen_US
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