Magnitude and associated factors of virological failure among children on ART in Bahir Dar Town public health facilities, Northwest Ethiopia: a facility based cross-sectional study

Abstract

Background Despite the rapid scale-up of antiretroviral therapy, virologic failure has become global public health concern and challenge, especially in developing countries. Viral load monitoring is an important approach to identify treatment failure and develop public health interventions in children receiving antiretroviral therapy. Thus, this study aims to assess the magnitude and associated factors of virological failure among children on antiretroviral therapy. Methods A facility-based cross-sectional study was conducted among 399 HIV-positive children on antiretroviral therapy from 2016 to 2019 in Bahir Dar Town public health facilities. Data were extracted from children’s charts using a standardized data extraction tool, adapted from ART intake and follow-up forms. Data were entered using Epi-Data Version 3.1, and analyzed using SPSS Version 25. Bivariable and multivariable binary logistic regression models were done to identify factors associated with virological failure. Variables with p-values < 0.25 were fitted into the multivariable analysis. Finally, variables with p-values <0.05 were considered as statistically significant factors. Results The period prevalence of virological failure was found to be 14.8% (95% CI: 11.5–19.3%). Opportunistic infections (AOR = 2.19, CI: 1.13–4.25), history of treatment interruption and restart (AOR = 2.21, CI: 1.09–4.54), younger age (AOR = 2.42, CI: 1.02–5.74), poor/fair ART adherence (AOR = 2.19, CI: 1.05–4.57), and advanced baseline WHO clinical staging (AOR = 2.32, CI: 1.14–4.74) were found to be factors significantly associated with virological failure. Conclusion The magnitude of virological failure among HIV-infected children remained high. Children with poor/fair ART adherence, history of treatment interruption, advanced baseline WHO clinical staging, younger age, and opportunistic infections were significantly associated with virologic failure. Thus, special attention should be given to children who had poor/fair ART adherence and presenting with opportunistic infections.

Predictors of unsuppressed viral load among adults on follow up of antiretroviral therapy at selected public and private health facilities of Adama town: unmached case-control study

“…Unless regimen changed / substituted due to these possible causes is well monitored, there could be a concern of medication intolerance, adherence, and drug resistance which subsequently affect viral suppression. However this study is not consistent with study done in Bahir Dar in which regimen change has no any significant association [35]. The possible reason might be the difference in inclusion criteria and the type of the health facilities included in the study which might differ in quality of care and treatment.…”

Prevalence and associated factors of treatment failure among children on ART in Ethiopia: A systematic review and meta-analysis

“…Regarding prevalence, the lowest prevalence (3.1%) of treatment failure was reported from a study done in Southern Nations, Nationalities, and Peoples Region (SNNPR) [ 21 ], whereas the highest prevalence (18.8%) was reported in study done at Fiche and Kuyu hospitals in Oromia Region [ 23 ]. Concerning quality of the included studies, two studies [ 19 , 25 ] were assessed based on JBI check list for cross-sectional studies, and the remaining eight studies [ 18 , 20 – 24 , 26 , 27 ] based on JBI check list for cohort studies. According to this quality assessment criterion, all studies were included.…”

“…From a single study, HIV positive children have not both parents as primary caretakers (AOR = 2.72, 95% CI: 1.05, 7.06], and negative serologic status of their caretakers (AOR = 2.69, 95% CI: 1.03, 7.03) were at high risk of treatment failure [ 27 ]. Age of children below 5 years (AOR = 2.4, 95% CI: 1.0–5.7) [ 25 ] was also reported as a contributing factor for the occurrence of HIV treatment failure as compared to their counterparts. Likewise, HIV positive children with age below 3 years were at high risk (AHR = 1.85, 95% CI: 1.24, 2.76) to develop treatment failure as compared to those with age between 5 and 15 years [ 22 ].…”

“…The estimated pooled effects of advanced WHO clinical stage III/IV on HIV treatment failure was (AOR = 1.66; 95% CI: 1.24, 3.21) as compared to those children categorized on WHO clinical stage I/II. Report from a single study showed that children who interrupt and restart their HIV treatment were positively (AOR = 2.21, 95% CI: 1.09, 4.54) associated with treatment failure [ 25 ]. HIV positive children who had height for age below or on 3 rd percentile were at high risk (AHR = 3.3, 95% CI: 1.0, 10.6) of treatment failure [ 22 ].…”

Virological failure of first-line antiretroviral therapy in children living with HIV in Indonesia and associated factors

“…2,3 The use of antiretroviral therapy (ART) that combines two or more drugs has significantly reduced morbidity and AIDS-related mortality among infected children. 4,5 The goal of ART is to suppress viral replication, resulting in decreased HIV-RNA VL. 6 The World Health Organization (WHO) recommends routine viral load monitoring for all PLHIV on ART to assess treatment response and disease progression.…”