{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:00:27Z","timestamp":1782824427154,"version":"3.54.5"},"reference-count":36,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Despite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of \u2018test and treat\u2019 remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a retrospective open cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was survival status at the end of follow-up, defined as death versus alive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85\u2009972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (\u226535 years), bedridden (AHR 2.46, 95%\u2009CI 1.78 to 3.40)\u2009and ambulatory status (AHR 2.33, 95%\u2009CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95%\u2009CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95%\u2009CI 1.13 to 1.76) and baseline CD4 &lt;200\u2009cells\/mm\u00b3 (AHR 3.08, 95%\u2009CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95%\u2009CI 0.30 to 0.43).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112825","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:20:40Z","timestamp":1774534840000},"page":"e112825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Survival and predictors of mortality among people living with HIV (PLHIV) on antiretroviral therapy in Ethiopia (2016\u20132023): a retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9342-4747","authenticated-orcid":false,"given":"Minilik Demissie","family":"Amogne","sequence":"first","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abeje","family":"Kebede","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derbachew","family":"Asfaw","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getahun","family":"Fetensa","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feyissa","family":"Lemessa","sequence":"additional","affiliation":[{"name":"St Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kidist","family":"Zealiyas","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6107-9221","authenticated-orcid":false,"given":"Wudinesh Belete","family":"Belihu","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wegene","family":"Tamene","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemechu","family":"Gudeta","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1153-2355","authenticated-orcid":false,"given":"Feyiso Bati","family":"Wariso","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getnet","family":"Hailu","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1240-6743","authenticated-orcid":false,"given":"Amelework Yilma","family":"Shiferaw","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0257-5612","authenticated-orcid":false,"given":"Lemessa","family":"Debel","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Worku","family":"Dechassa","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bira","family":"Bejiga","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiflu","family":"Itefa","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6080-0200","authenticated-orcid":false,"given":"Belete Woldesemayat","family":"Hailemariam","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebe","family":"Habtesilase","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dereje","family":"Yenealem","sequence":"additional","affiliation":[{"name":"HIV and other STI research Division, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7390-1788","authenticated-orcid":false,"given":"Tariku 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HIV antiretroviral therapy in ethiopia. overcoming implementation challenges. 2007."},{"key":"2026032607201765000_16.3.e112825.7","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12403"},{"key":"2026032607201765000_16.3.e112825.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-08988-9","article-title":"Burden and changes in HIV\/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990\u20132017","volume":"20","author":"Gona","year":"2020","journal-title":"BMC Public Health"},{"key":"2026032607201765000_16.3.e112825.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0627-9"},{"key":"2026032607201765000_16.3.e112825.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12981-020-00307-x","article-title":"Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study","volume":"17","author":"Kebede","year":"2020","journal-title":"AIDS Res Ther"},{"key":"2026032607201765000_16.3.e112825.11","doi-asserted-by":"crossref","unstructured":"Chekole B , Belachew A , Geddif A , et al . 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