Magnitude of first line antiretroviral therapy treatment failure and associated factors among adult patients on ART in South West Shoa, Central Ethiopia

Abstract

Background First-line antiretroviral treatment failure has become a public health concern in high, low and middle-income countries with high mortality and morbidity In Ethiopia, around 710,000 peoples were living with HIV and 420,000 of them were receiving ART in 2017. Little is known about the magnitude of first-line ART treatment failure and its associated factors in Ethiopia, particularly in the study area. Therefore, this study was aimed to find the magnitude of first-line ART treatment failure and its associated factors among adult patients attending ART clinic at Southwest shoa zone public hospitals. Methods Institutions based cross-sectional study was employed from February 1 to April 2, 2019. An interviewer administered questionnaire was used to collect data from 350 adult patients on ART using a systematic random sampling technique. The collected data were coded and entered into Epidata version 3 and exported to STATA SE version 14 for analysis. Bivariable and multivariable logistic regression was done to identify factors associated with first-line ART treatment failure. At 95% confidence level strength of association was measured using Odds ratio. Variables with a p-value of ≤ 0.25 in the bivariable analysis were considered as a candidate variable for multivariable analysis. To get the final variables step-wise backward selection procedure was used and those in the final model were selected at a p-value <0.05. Finally, texts, simple frequency tables, and figures were used to present the findings. Results In this study the magnitude of first-line ART treatment failure was 33.42%. Absence of baseline opportunistic infection AOR = 0.362 (95%CI0.178, 0.735), Staying on first-line ART for <5 years AOR = 0.47 (95%CI 0.252, 0.878), Nevirapine containing ART regimen AOR = 3.07 (95%CI 1.677, 5.63), Baseline CD4 count ≥100 cells/mm3 AOR = 0.299 (95%CI 0.152 0.591), absence of opportunistic infections after ART initiation AOR = 0.257 (95%CI 0.142, .467), time taking greater than an one-hour to reach health facility AOR 1.85 (95%CI 1.022 3.367) were significantly associated with first-line ART treatment failure. Conclusion The magnitude of first-line ART treatment failure was high in the study area. Base-line opportunistic infection, duration on first-line ART, NVP based ART, Baseline CD4 count level, OI after ART initiation, and time it takes to reach health facility were independent determinants of first-line ART treatment failure.

Determinants of Therapy Failure Among Adults on First-line Antiretroviral Therapy in Asmara, Eritrea: A Multicenter Retrospective Matched Case-control Study

“…Further, we demonstrated that low CD4 + cell count (baseline CD4 + cell count of <50 and ≤100 cells/ µl) were associated with increased odds of VF. Comparable results have been reported in Ethiopia [26, [33][34][35], and Kenya [36], among others. To explain this relationship, the inverse relationship between CD4 + cell count and viral replication at speci c stages of the disease has been invoked [33].…”

“…Comparable results have been reported in Ethiopia [26, [33][34][35], and Kenya [36], among others. To explain this relationship, the inverse relationship between CD4 + cell count and viral replication at speci c stages of the disease has been invoked [33]. In addition, a low CD4 + cell count is a marker of advanced disease, hence the potential presence of HIV-de ning infections.…”

“…NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor Demographic and Clinical characteristics of patients Among the 1068 participants (356 cases and 712 controls), females account for 45.2% (N=483) and median age at enrollment was 46 years (IQR: 39-51 years) ranging from 15 years to 86 years. Males were older at enrollment than females (39 years [IQR:[33][34][35][36][37][38][39][40][41][42][43]] vs 32 years [IQR: 27 -37]), p-value< 0.001. The mode of entry to clinical care for cases was less through VCT than controls (51.1% vs 61.5%, p < 0.001) (Table1).…”

Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case–control study

“…Further, we demonstrated that low CD4 + cell count (baseline CD4 + cell count of < 50 and ≤ 100 cells/ µl) were associated with increased odds of TF. Comparable results have been reported in Ethiopia [ 27 , 34 – 36 ], and Kenya [ 37 ], among others. To explain this relationship, the inverse relationship between CD4 + cell count and viral replication at specific stages of the disease has been invoked [ 34 ].…”

Methicillin resistance Staphylococcus aureus nasal carriage and its associated factors among HIV patients attending art clinic at Dessie comprehensive specialized hospital, Dessie, North East Ethiopia

“…First line ARV failure was reported in studies conducted in Addis Ababa and Gondar [35][36][37]. Presence of opportunistic infection, no formal education, low CD4 count and patients having respiratory infection like tuberculosis are important predictors of treatment failure among HIV patients [35,36,38,39]. Staphylococcus aureus is normal human bacterial flora and is considered as a cause of a wide range of opportunistic…”