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

Dagnaw

et al. 2020

Preprint

Background: Nowadays Human Immuno-deficiency Virus (HIV) is one of the devastating and prevalent virus affecting the globe without a cure. Highly Active Antiretroviral Therapy (HAART) significantly reduced the morbidity and mortality of patients with HIV infection. Although there is increasing global use of antiretroviral therapy (ART) for the treatment of HIV/AIDs, the global trends in ART failure is growing. In developing countries including Ethiopia, particularly in our study settings, information related to magnitude and correlates of virological treatment failure is scarce. Thus, this study aimed at assessing the magnitude of virological treatment failure and associated factors among HIV reactive adults at selected hospitals of north Shoa, Amhara Region, Ethiopia.Methods: a facility based cross-sectional study was conducted among 498 study participants who started their first-line HAART from August 2005 to December 2018. Data were collected from patients’ charts and face-to-face interviews using a structured questionnaire. Bivariable analysis was executed to select candidate predictor variables at a p-value less than 0.2. Multivariable logistic regression (forward stepwise, conditional) analysis was used to identify factors associated with virologic failure at significant level of 5%. Model adequacy check was done by Hosmer and Lemshow (p = 0.57) and Naglkerke R Square (0.46) was calculated to express the variability of virological failure by predictors.Result: More than half 290 (58.2%) of study participants were females. The median age at ART initiation was 40 years with an interquartile range (IQR) of 15 years. The median duration of virologic failure since initiation of treatment was 96 months (IQR) of 72. The magnitude of virological treatment failure was 10.24% (95% CI: 7.57% - 12.91%). Poor ART drug adherence (AOR = 4.54; 95% CI: 2.09, 9.87), CD4 count less than 250 cell/μl (AOR = 24.88; 95% CI: 11.73, 52.81) and Poor Quality of Life (QoL) (AOR = 2.65; 95% CI: 1.12, 6.25) were independent predictors of virologic failure. Conclusion: The magnitude of Virologic ART treatment failure in this study was relatively high. Poor ART drug adherence, patients’ having lower CD4 count and poorer quality of life were predictors of treatment failure. Thus, intervention program that enrich patients’ health related quality of life should be implemented. Moreover, counselling that supplement the importance of drug adherence and reduction of risks that lowers CD4 counts should be given emphasis which in turn helps to prevent first-line ART treatment failure.

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Section: Operational Definitionsupporting

confidence: 90%

Magnitude and Factors Affecting Virological Treatment Failure among HIV Reactive Adults from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia.

Dagnaw

et al. 2020

Preprint

show abstract

“…This finding is consistent with a systematic review conducted in Ethiopia (28). Medication adherence has an opportunity for best viral suppression, immune recovery, and as a result clinical benefit will be gained.…”

Section: Socio-demographic Characteristics Of Patientssupporting

confidence: 89%

Magnitude and Factors Affecting Virological Treatment Failure among HIV Reactive Adults from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia

Dagnaw

et al. 2020

Preprint

Background Nowadays Human Immuno-deficiency Virus (HIV) is one of the devastating and prevalent viruses affecting the globe without a cure. Highly Active Antiretroviral Therapy (HAART) significantly reduced the morbidity and mortality of patients with HIV infection. Although there is increasing global use of antiretroviral therapy (ART) for the treatment of HIV/AIDs, the global trends in ART failure are growing. In developing countries including Ethiopia, particularly in our study settings, information related to the magnitude and correlates of virological treatment failure is scarce. Thus, this study aimed at assessing the magnitude of virological treatment failure and associated factors among HIV reactive adults at selected hospitals of North Shoa, Amhara Region, Ethiopia. Methods a facility-based cross-sectional study was conducted among 498 study participants who started their first-line HAART from August 2005 to December 2018. Data were collected from patients’ charts and face-to-face interviews using a structured questionnaire. The bivariable analysis was executed to select candidate predictor variables at a p-value of less than 0.2. Multivariable logistic regression (forward stepwise, conditional) analysis was used to identify factors associated with virologic failure at a significant level of 5%. Model adequacy check was done by Hosmer and Lemeshow (p = 0.57) and Naglkerke R Square (0.46) was calculated to express the variability of virological failure by predictors. Result More than half 290 (58.2%) of the study participants were females. The median age at ART initiation was 40 years with an interquartile range (IQR) of 15 years. The median duration of virologic failure since initiation of treatment was 96 months (IQR) of 72. The magnitude of virological treatment failure was 10.24% (95% CI: 7.57% − 12.91%). Poor ART drug adherence (AOR = 4.54; 95% CI: 2.09, 9.87), CD4 count less than 250 cell/µl (AOR = 24.88; 95% CI: 11.73, 52.81) and Poor Quality of Life (QoL) (AOR = 2.65; 95% CI: 1.12, 6.25) were independent predictors of virologic failure. Conclusion The magnitude of Virologic ART treatment failure in this study was relatively high. Poor ART drug adherence, patients’ having lower CD4 count and poorer quality of life were predictors of treatment failure. Thus, an intervention programs that enriches patients’ health-related quality of life should be implemented. Moreover, counseling that supplements the importance of drug adherence and reduction of risks that lower CD4 counts should be given emphasis which in turn helps to prevent first-line ART treatment failure.

show abstract

“…This discrepancy may be due to most clients on first-line ART treatment failure shift to second-line ART. This 10.2% virological treatment failure indicated that first-line ART treatment may not be effective, as WHO recommends changing their first-line ART regimen if levels of Non-nucleoside reversetranscriptase inhibitor (NNRTI) pretreatment HIV drug resistance (PDR) reach 10%, 27 so further investigations is needed on pretreatment HIVDR to NNRTIs. The current study showed that ART treatment adherence was the independent reason for the virological treatment failure and patients with poor ART drug adherence were 4.5 times at higher risk of developing treatment failure compared to patients with good ART drug adherence.…”

Section: Discussionmentioning

confidence: 99%

<p>Virological Treatment Failure Among Adult HIV/AIDS Patients from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia</p>

Mekuria

et al. 2020

IDR