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

Simple item page
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.accessioned2024-05-22T06:45:24Z
dc.date.available2024-05-22T06:45:24Z
dc.date.issued2024
dc.description.abstractBackground Cryptococcal 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. Methods We conducted a retrospective study at Lira Regional Referral Hospital in Uganda evaluating long-term survival (�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. Results 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 CMDTP 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 <0.001), weight >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). Conclusion 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 M, Link A, Opio B, Okello F, Nakato R, Nabongo B, et al. (2024) Poor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Uganda. PLoS ONE 19(5): e0303805. https://doi.org/10.1371/journal.pone.0303805en_US
dc.identifier.urihttps://doi.org/10.1371/journal.pone.0303805
dc.identifier.urihttp://ir.lirauni.ac.ug/xmlui/handle/123456789/826
dc.language.isoenen_US
dc.publisherPLoS ONEen_US
dc.subjectcryptococcal meningitisen_US
dc.subjectNorthern Ugandaen_US
dc.titlePoor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Ugandaen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
RESEARCH ARTICLE.pdf
Size:
633.11 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

Research Articles