Second-line antiretroviral therapy adherence and associated factors among adults living with HIV in Dessie City administration public hospitals, Northeast Ethiopia, 2021

Abstract

Background Adherence is a strong predictor of second-line treatment failure. Second-line treatment failure results in increased morbidity and mortality for HIV-positive patients and is a risk factor for HIV transmission, including drug-resistant strains. Patients failing second-line antiretroviral therapy (ART) regimens need third-line antiretroviral drugs, which are too costly for sub-Saharan Africa. Therefore, understanding patients’ second-line antiretroviral drug adherence level and associated factors has a significant impact on preventing and managing poor adherence-associated complications. There is limited information on this topic in Ethiopia, particularly in the current study area. Objective The main aim of this study was to assess the magnitude of second-line antiretroviral therapy adherence and associated factors among adults living with HIV in Dessie City administration public hospitals, North East Ethiopia, 2021. Methods An institution-based cross-sectional study was conducted from February 25 - April 30, 2021, on 394 patients on second-line ART. A systematic random sampling technique was used to identify the study participants. Data were collected by using a pretested, structured interviewer-administered questionnaire. Data were entered using Epi-data version 4.2 and exported to the Statistical Package for Social Sciences (SPSS) version 23 for further analysis. Bivariable and multivariable binary logistic regression analyses were performed to identify factors associated with the outcome variable. In the bivariable binary logistic regression analysis, variables with p values less than 0.25 were candidates for multivariable binary logistic regression. Adjusted odds ratios and 95% confidence intervals with p values < 0.05 were used to declare statistical significance in the multivariable binary logistic regression. Results In this study, 66.8% (95% CI: 61.9%, 71.3%) of patients on second-line ART had good adherence to their ART medication. Having an adherence supporter (AOR = 2.8; 95% CI: 1.65, 4.75), having a good first-line ART adherence history (AOR = 3.32; 95% CI: 1.43, 7.69), being male (AOR = 1.71; 95% CI: 1.05, 2.78), having a history of substance use (AOR = 0.33; 95% CI: 0.19, 0.55) and having ever missed their visit (AOR = 0.49; 95% CI: 0.28, 0.86) were independently associated with the second-line ART adherence level. Conclusion and Recommendation: The magnitude of good adherence to second-line ART drugs was low. Being male, having support from an adherence supporter, having a history of substance use, having a good first-line adherence history and having a history of ever missing their visit were independently associated with second-line ART adherence. It is important to strengthen adherence strategies at both the facility and community levels by assisting patients who are likely to miss appointments and promoting social support.