Magnitude and predictors of antiretroviral treatment failure among HIV-infected children in Fiche and Kuyu hospitals, Oromia region, Ethiopia: a retrospective cohort study

Abstract

The objective of the study was to assess the magnitude and predictors of first‐line antiretroviral treatment failure among HIV‐infected children. A retrospective cohort study was conducted between January 2006 and December 2015. All pediatric patients of <15 years old and who took at least 6 months of ART in Fiche and Kuyu hospitals of Oromia region, Ethiopia were included in the study. Collected data were entered and analyzed using SPSS version 20. Multivariable logistic regression was employed to identify predictors of treatment failure. Data of 269 children were analyzed and majority (53.9%) of the children were males with a mean age of 9.8 ± 3.64 years. Based on the two WHO criteria, overall ART failure was found to be 51 (18.8%), of which 33 (12.26%) had clinical and 18 (6.69%) had immunologic failures. The mean time to the detection of treatment failure was 41 ± 24.96 months. Children's age between 6 and 9 years (AOR = 0.26, 95% CI: 0.09, 0.72) was protective toward treatment failure, while lost to follow‐up (AOR = 7.54, 95% CI: 2.35, 24.16), died (AOR = 22.22, 95% CI: 3.75, 131.54), transferred out (AOR = 3.34, 95% CI: 1.41, 7.87), suboptimal adherence to ART (AOR = 4.85, 95% CI: 1.82, 12.93), baseline CD4 count of <50 cells/mm3 (AOR = 4.28, 95% CI: 3.49, 5.9), and WHO advanced clinical stage (AOR = 2.46, 95% CI: 1.14, 5.31) were found to be predictors of treatment failure. The study revealed that the treatment failure is high and the mean time to develop treatment failure is short. The predictors for treatment failure were suboptimal adherence, lost to follow‐up, transferred out, initial CD4 count <50 cells/mm3, initial WHO stages 3 and 4. On the other hand, being in the age of 6–9 years is protective from developing treatment failure as compared to the other age category.

HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis

“…Studies found through databases search were done between 2005 and 2016. Eight of the studies were conducted in the Amhara region, whereas five in Addis Ababa [13,[21][22][23][24], three in Oromia [18,25,26], one in Tigray [14], and one in SNNPR [27]. Three studies were done by case-control study design [24,28,29], four studies by cross-sectional [14,[30][31][32], and eleven by cohort study design [13, 15-18, 21-23, 25-27].…”

“…Three studies were done by case-control study design [24,28,29], four studies by cross-sectional [14,[30][31][32], and eleven by cohort study design [13, 15-18, 21-23, 25-27]. Ten studies were done on adult population [13, 16, 17, 21, 23-25, 28, 29, 32], six on children [15,18,22,26,27,31], and two on all age group [14,30] (Table 1).…”

“…Based on a single study report, children's age between 6 and 9 years (AOR = 0.26; 95% CI: 0.09-0.72) was protective towards HIV treatment failure as compared to 10-15 years old children [18]. Another study showed children less than 3 years old were high risk (AHR = 1.85; 95% CI: 1.24-2.76) for HIV treatment failure as compared to 5-15 years old children [22].…”

“…A higher viral load may lead to HIV treatment failure, which is becoming a threat of different African countries, like in Burkina Faso (6.4%) [10], Ghana (15.7%) [11], and Tanzania (14.9%) [12]. In Ethiopia, virological, immunological, and clinical failure is found in the range between 1.3% [13] to 11.5% [14], 2.1% [15] to 21% [16], and 3.1% [17] to 12.3% [18], respectively.…”

Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia

“…A higher viral load may leads to HIV treatment failure, which is becoming a threat of different African countries, like in Burkina Faso (6.4%) (12), Ghana (15.7%) (13), and Tanzania (14.9%) (14). In Ethiopia, virological, immunological, and clinical failure found to be in the range between 1.3% (15) to 11.5% (16), 2.1% (17) to 21% (18), and 3.1% (19) to 12.3% (20) respectively.…”