title: Temporal trends in death causes in adults attending an urban HIV clinic in Uganda: a retrospective chart review.
abstract: OBJECTIVE
  To study temporal trends of mortality in HIV-infected adults who attended an HIV clinic in Kampala, Uganda, between 2002 and 2012.
  
  
  METHODS
  Descriptive retrospective study.
  
  
  METHODS
  Two doctors independently reviewed the clinic database that contained information derived from the clinic files and assigned one or more causes of death to each patient >18 years of age with a known date of death. Four cause-of-death categories were defined: 'communicable conditions and AIDS-defining malignancies', 'chronic non-communicable conditions', 'other non-communicable conditions' and 'unknown'. Trends in cause-of-death categories over time were evaluated using multinomial logistic regression with year of death as an independent continuous variable.
  
  
  RESULTS
  1028 deaths were included; 38% of these individuals were on antiretroviral therapy (ART). The estimated mortality rate dropped from 21.86 deaths/100 person years of follow-up (PYFU) in 2002 to 1.75/100 PYFU in 2012. There was a significant change in causes of death over time (p<0.01). Between 2002 and 2012, the proportion of deaths due to 'communicable conditions and AIDS-defining malignancies' decreased from 84% (95% CI 74% to 90%) to 64% (95% CI 53% to 74%) and the proportion of deaths due to 'chronic non-communicable conditions', 'other non-communicable conditions' and a combination of 'communicable and non-communicable conditions' increased. Tuberculosis (TB) was the main cause of death (34%). Death from TB decreased over time, from 43% (95% CI 32% to 53%) in 2002 to a steady proportion of approximately 25% from 2006 onwards (p<0.01).
  
  
  CONCLUSIONS
  Mortality rate decreased over time. The proportion of deaths from communicable conditions and AIDS-defining malignancies decreased and from non-communicable diseases, both chronic and non-chronic, increased. Nevertheless, communicable conditions and AIDS-defining malignancies continued to cause the majority of deaths, with TB as the main cause. Ongoing monitoring of cause of death is warranted and strategies to decrease mortality from TB and other common opportunistic infections are essential.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Cox
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kiggundu
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Lana
authors.initials: L
authors.lastname: Elpert
authors.affiliation: Department of Medicine, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.affiliation: Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda.
authors.forename: Stella
authors.initials: S
authors.lastname: Alamo
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease; D060085:Coinfection / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000401:mortality; D014454:Uganda / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data
keywords: INFECTIOUS DISEASES