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研究生:卡飛傑
研究生(外文):Philip James Castillo
論文名稱(外文):A Retrospective Cohort Study on Factors Associated with Mortality among HIV Infected Individuals in Belize
指導教授:簡莉盈簡莉盈引用關係
指導教授(外文):Li-Yin Chien
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
畢業學年度:98
語文別:英文
論文頁數:66
中文關鍵詞:N/A
外文關鍵詞:BelizeHIV/AIDSHAARTdeath
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Background: In 2005 Belize had an estimated prevalence of Human Immunodeficiency Viral infection of 2.1%, the fifth among ten countries of the Caribbean. HIV infection
constitutes a major public health problem and had been among the five leading causes of death in Belize in 2005.
Objective: To examine the predictive factors for death among HIV individuals more than 15 years of age from 2001 to 2007 in the country of Belize.

Methods: A total of 1352 persons diagnosed with HIV/AIDS from 2001–2006 and had lived at least one year after enrollment during the study, during the period 2001 to 2007
and who were registered in the database of the National Health Information System of Belize. It is a retrospective cohort study where socio-demographic, clinical and access
data were recorded. Logistic regression was performed to evaluate factors associated with death.

Results: Between 2001 and 2007, mortality was 3.3 per 100 person years, the cumulative mortality rate was 7.7%, mean age 33.83 years and standard deviation 8.36. Finding in
the socio-demographic variables shows that Age of diagnosis is a significant predictor of death, with the youngest group aged 15 to 19 having the highest odds (OR, 36.59) followed by those 31 to 45 years( OR, 10.16) and those 20 to 30 years (OR, 9.58).
Those with unknown education level had significantly higher odds of death ( OR 6.45) than those who had none or only primary education. Those persons diagnosed in the
pre-HAART period had significantly higher odds of death (OR 2.17) compared to those diagnosed during the post HAART period. Occupation significantly predicted death with
the technical laborers having the highest odds of death (OR, 78.37 ) followed by the domestic/ farmers (OR, 9.96) and the non-technical laborers (OR, 2.62). Persons who lived in the southern region had significantly higher odds of death (OR, 5.06) than those who live in the central region; there was no significant risk of death for those who live in the northern and western regions compared to those in the central region.
Presence of opportunistic infection significantly increased the risk of death, with generalized lymphadenopathy due to multiple infections having the highest risk (OR=165.20), followed by respiratory infections(OR=23.67, and diarrhea infections (OR 8.79). People who were compliant to HAART had significantly higher odds of death (OR=2.07) than those non compliant; and there were no significant differences in risk of death for those not compliant and those not on HAART. Subjects with CD4 test results were more likely to die regardless of the test results being suboptimal (OR=3.48) or
optimal ( OR=2.61) than those without CD4 test count done.
Subject who traveled from village to cities/towns for health care (OR=10.4) were significantly at higher odds of death than those who travel within the city for care.

Conclusions: These results from this study confirm the role of the age of diagnosis on mortality and implies the need for capacity building and coping mechanisms for those diagnosed at a younger age. Clearly there is the need for better data collection techniques so that the mortality of those with unknown education level could be better explained
Mortality among all occupation groups is a unique finding in this study compared to other studies reviewed during this research and there is the need for further research to explain the association between socio-economic factors and AIDS mortality. The results confirm the predominant role opportunistic infection in the death of HIV subjects in Belize. This implies the need for the early detection of infections and the diagnosis of bacteremia as well as the timely use of antibiotic prophylaxis. Of particular concern is the observation of death among those on HAART and with optimal CD4. This suggest the need for early diagnosis of HIV status, early initiation of HAART, advocating for HAART use among doctors and patients and to increase access to treatment by the decentralization of ARV.
Table of Content

1. Introduction ……………………………………………………………………1
1.1 Global Dimension…………………………………………………....1
1.2 HIV Epidemic in the Caribbean……………………………............2
1.3 Belize……………………………………………………………..…..3
1.4 Health Services in Belize………………………………………..…..4

2. Background and significance………………………………………………….7
2.1 Motivation to conduct this study……………………………….…..8

3. Literature Review……………………………………………………………..10
3.1 Predictive Factors for HIV Death, Overview……………………10
3.2 Gender………………………………………………………………10
3.3 Age, education and place of Death…………….…………….…….11
3.4 Infectious Disease……………………………………………...……11
3.5 Marital Status…………………………………………….…………12
3.6 Occupation……………………………………………………….….12
3.7 CD4 count…………………………………………..……………….13
3.8 HAART……………………………………………………….……..13

4. The Study………………………………………………………………………15
4.1 Study Objective……………………………………………………..15
4.2 Specific Objectives……………………………………………...…..15
4.3 Study question………………………………………………………15


5. Methodology…………………………………………..……………………….17
5.1 Study Population…………………………………………...……….17
5.2 Data source and study design…………………...………………….17
5.3 Definitions………………………………………………..………….18
5.4 Measurement, Routine HIV care and HAART treatment…….....19
5.5 CD4, VDRL and Hepatitis B…………………………..……………21
5.6 Statistical analysis…………………………………………...………22
5.7 Variables……………………………………………………………..23







VIII
6. Results
6.1 Personal Characteristics of Study population……………....…26
6.2 Clinical Variables……………………………………………..…30
6.3 Mortality……………………………………………………….....31
6.4 Inferential Statistics on Socio-demographic Variables…….….32
6.5 Inferential Statistics on Clinical Variables……………………..34
6.6 Inferential Statistics on Access Variables……………………....36
6.7 Predictors of Death…………………………………………..…..38
6.7.1 Age of Diagnosis as a Predictor of Death………………..…….38
6.7.2 Education level as a Predictor of Death ………………………38
6.7.3 Period of Diagnosis as a Predictor of Death………….………..38
6.7.4 Occupation as a Predictor of Death……………….………..…..39
6.7.5 Health Region as a Predictor of Death………………….….…..39
6.7.6 CD4 as a Predictor of Death……………………...…………….39
6.7.7 HAART as a Predictor of Death………………………...…….39
6.7.8 Opportunistic Infection as a Predictor of Death…………...….40
6.7.9 Travel for Care as a Predictor of Death…………………….….40

7. Discussion…………………………………………..………………………..41
7.1 Mortality…………………………………….……………………41
7.2 Socio-demographic effects on Mortality………………..………42
7.3 Education level and occupation effects on Mortality…………..43
7.4 Effects of HAART treatment on Mortality……………………..45
7.5 Effects of Opportunistic infections on Mortality……………….47
7.6 Effects of Health Region and access on Mortality………...……48
7.7 Other conditions that affect mortality…………………..………49
7.8 Study limitations …………………………………………………50


8. Conclusions…………………………………………………………………..51

9. References………………….………………………………………………..54



10. Appendices…………………………………………………………………...59
10.1 Adult and Pediatric HAART Regimes, Ministry Of Health, Belize
10.2 Algorithm Of HIV Testing in Belize
10.3 Estimated HAART Coverage 2007, Belize
10.4 IRB
10.5 Map of Central America
10.6 Map of Belize

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